I have always been fascinated with the processes involved in our healthcare system and how to go about improving them. It’s no secret that our system is flawed, maybe even broken. It’s confusing, frustrating, overly complex and largely inefficient. Why?
The U.S. spends almost double what other countries spend in healthcare as a percentage of our GDP. Our system is vastly different from that of other developed nations, and administrative “burden” is heavily blamed for the difference in cost. It’s certainly part of the problem; we spend significantly more than other countries in this area. With most of the nation’s insured patients having employer sponsored insurance, insurance coverage and billing practices vary widely from plan to plan.
People must be hired by clinics and hospitals who can understand those practices, bill for services, address issues in denied claims, answer patient’s questions about their coverage, etc. Those are all things that physicians didn’t go to medical school to do. We do need people to perform these jobs, regardless of the type of healthcare system we have, for that reason. The web of administrative functions has just gotten too interwoven to be efficient.
How the United States Compares to Other Nations
On the topic of physicians, we pay our doctors more than other countries, which is largely justified by how much we charge them in tuition to get the education they need to legally work in this profession. The investment made in their training is vital to both their success as a doctor and our health and safety as a nation. However, that means they don’t start earning a salary until their late twenties (assuming they begin medical school fairly soon after graduating from college), and many have racked up hundreds of thousands of dollars in student loans.
Even after all this investment into our physicians and the administrative support system, our quality of care just doesn’t reflect it. The third leading cause of death in the U.S. is medical error, right behind heart disease and cancer. Infant mortality is 71% higher than the comparable country average, or the average of similarly developed nations (think Japan, Sweden, France, the UK, etc.). We rank 26th in life expectancy. How is one of the richest countries in the world this far behind?
What is the Solution?
We just can’t answer that question simply. We don’t know that a single payer system would magically solve all our problems, although it seems to work well for other developed countries, and we don’t know that federally funded higher education would be the best answer either. So what should we be focusing on instead? How do we address these issues without entirely overriding our system and starting from the ground up?
- Simplify the complexity and uniqueness of our insurance system by streamlining billing procedures and defining acceptable coverage (largely helped by the ACA)
- Focus on preventive care rather than reactive/downstream care, which requires more spending on public health education efforts and spreading accurate, unbiased clinical knowledge
- Connect the fragmented technology that leads to duplication of care and unnecessary spending (i.e. EMRs that can “speak” to each other)
- Make Medicaid expansion federally mandated so that our most vulnerable citizens receive the preventive care they need to stop the advancement of costly, complex chronic diseases
The Future of the Healthcare System
As someone who is fascinated with the juxtaposition of healthcare and business in the U.S., I could write entire blog posts on each of those bullets. And maybe I will. For now, I challenge you to think critically about our healthcare system and how the wide breadth of these issues affect mental healthcare in particular. Psychiatry has many other hurdles to overcome, including but not limited to stigma, lack of accessibility, and being a relatively young branch of medicine. We work tirelessly at Iris to overcome these struggles via telepsychiatry. It’s an uphill battle, but by addressing the root of the problems plaguing the larger system, we can expand telepsych’s reach to its fullest potential.
Mallory Martin is the Credentialing Coordinator for Iris Telehealth. She graduated from the University of Texas at Austin with a BBA in Management and a focus in the business of healthcare. Her opinions do not reflect those of Iris Telehealth.