If you are reading this, it is likely that you are furious about the cost of care in the US, opaque pricing, exhorbitant out of pocket expenses, unaffordable health insurance that leaves you holding the bag or a bankruptcy declaration anyway and maddening care and billing experiences and service.
When it comes to medical debt, the US takes home the cake. A recent academic study found that 66.5% of all bankruptcies in the US were tied to medical issues — either because of high costs for care or time out of work. The research, which was published in the American Journal of Public Health, revealed that an estimated 530,000 families turn to bankruptcy each year because of medical issues. While some other industrial nations have health insurers, most avoid five-figure medical bills as a result of how insurers and doctors are regulated.
The US spends more than any other country because our prices are so high. Insurance costs more because our prices are so high. Our prices are so high because the system is not designed to restrain them and, consequently, there is no Moore's law for sick care services. Simply put, there are too many people benefitting from feeding from the $3.7T trough and none of the stakeholders want to say no.
We are intrigued by shiny new objects but ignore their costs. Will any of these reduce your insurance premium? Who going to pay for the future of medicine and how much?
What's the answer? There are two fundamental strategies in play- more centralized, government regulated payment, providing and pricing or market based solutions, or , some combination of a public and private system of systems.
Sick care is a wicked problem and, therefore, requires a systems engineering solution. Those should include:
- More value transparency about quality and price.
- More patient education about data literacy and how to shop for care by raising their health and insurance IQs.
- Empowering patients to change doctors without having to pay high tangible and intangible switching costs.
- Data interoperability and portability.
- Reforming medical education to include competencies in practicing the business of medicine and knowing what things cost and how to create and measure value.
- Eliminating unnecesary , ineffective treatments, waste and abuse by monitoring physician prescribing habits and "rehabilitating" them.
- Rethinking the CPT and relative value pricing system.
- Mandating cost effectiveness analysis for payment approval with better collaboration between the FDA and the CMS.
- Let Medicare negotiate prescription drug prices.
- Don't recommend preventive interventions for seniors, like the shingles vaccine, that Medicare won't pay for.
- Balance the Medicare fund by means testing contributions and benefits and/or, raising the eligibilty age from 65.
- Better use of data and clinical decision support to create a care pathway cost estimate before proceeding with non-emergent care. Think what it will cost to build your Ford before dealer discounts online.
- Informing patients about doctors who are dead, retired or out of network or, who refuse to see them because they won't make as much money as they would taking care of someone with better insurance or who are willing and able to pay cash.
- Removing the costs of unnecessary administrivia.
- Train the workforce of the future, unbundle primary care and migrate sick care to healthcare.
- Using finsicktech technologies to reduce the 30% administrative costs of Sickcare USA.
Even these ideas will fail if we can't translate them into lower costs and deal with the intended and unintended consequences of the changes.
The US sick care system of systems is an unsustainable house of cards that is collapsing. Someone needs to call a doctor. Too bad there are so few willing to take new patients.
Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@ArlenMD and Co-editor of Digital Health Entrepreneurship.
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