There are many misconceptions about health care and medical care. This includes the discussions over the last few years about healthcare reform but is not limited to those discussions. I plan to write about these over the coming days and weeks in some detail. Here is the first one. “American has the best healthcare system in the world.”
One of the first problems with this statement is that we really have a medical system in America not a healthcare system. We focus on “disease and pestilence” and dealing with acute problems as they arise but paying relatively little attention to disease prevention and health promotion. We spend more per capita on healthcare or, as I have stated just now, medical care on a per capita basis than any other country in the world yet our quality of care is not necessarily better. For example our infant mortality rate at 6.9 deaths per 5,000 births is substantially higher than Japan (2.8) or France (3.9). And our life span which is currently 77.9 years has not kept up with Japan (83) or Switzerland (82).
We all know that vaccines can prevent many very serious illnesses and yet some 20% of infants don’t receive the ones that they should receive by the end of the first year. And although the influenza vaccine had an enormous effect on reducing both morbidity and mortality of this disease, very large numbers of adults, who should know better, don’t bother to get the vaccine each year. Our lifestyles are clearly not what they should be where we largely eat a non-nutritious diet of processed foods in excess quantity, don’t exercise enough, are chronically stressed and 20% of us smoke. The result, among many other things, is obesity with a third of us overweight and a third of us frankly obese. All this leads to multiple chronic illnesses such as diabetes with complications, coronary artery disease, stroke, chronic lung and kidney disease and cancers. Many of us don’t have regular exams to look for very correctable issues such as high blood pressure, high cholesterol or the early diagnosis of cancer. Essentially we have a medical care system that responds reasonably well to acute problems as they arise but a system which is simply not as focused as it needs to be on disease prevention and wellness promotion.
Another reason why our healthcare or medical care system is not what it could be or should be is that we spend all too little time coordinating the care of those who have chronic illnesses. These are diseases which once developed will last a lifetime, are difficult to treat and are inherently expensive to treat. But all too often the quick response in the doctor’s office is to send the patient off for other specialists’ visits, for tests, imaging or a procedure. And when the patient sees the specialist the whole process is repeated again and again. The end result are all too many specialist visits, all too many tests, all too many imaging studies and the same for procedures and even hospitalizations. This is not good quality of care and it’s certainly very expensive care. What is clearly needed is a well coordinated system where one physician serves as the patient’s coordinator for their chronic illness or multiple chronic illnesses addressing all the patient’s needs in an organized manner and sending the patient as needed to various members of multi-specialty teams. This leads to much higher quality yet much lower costs of care.
Following a talk recently I was asked that if America’s healthcare system isn’t all it’s cracked up to be then which country’s system is the best? I had to think about that for a while and in the end I came to the conclusion that we still have the best when compared to everyone else but it really isn’t what is should be or could be. It will only truly be the best when it becomes a true healthcare system rather than a medical care system; when it focuses on prevention extensively; and when the care of chronic illnesses is routinely done in a coordinated fashion through a multi-specialty team. And in the process, it saves us all a lot of money.