Tag Archives: obamacare

Why Does Healthcare in the US Cost So Much?! Watch This!

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Defensive Medicine: A Cure Worse Than The Disease

Defensive Medicine: A Cure Worse Than The Disease

Great article about the perils of “defensive medicine”.  It’s a quick read and worth it! 

Book Review – How We Do Harm

How We Do Harm: A Doctor Breaks Ranks About Being Sick in America by Otis Webb Brawley, M.D., with Paul Goldberg

I thoroughly enjoyed this book, and it illustrates some sinister complications with the US healthcare system. The author provides some fascinating statistical information regarding a variety of medical subject matter. His illustration of life-altering treatments evokes thought-provoking skepticism from the reader. Simultaneously, physicians who read this book should be encouraged to develop honest relationships with their patients. To be a good doctor, you must put the patient first, before prosperity and/or prestige.

There are few things that detract from my giving it a 5/5 rating, however. Unfortunately, the author expresses a fixation on racial stereotyping throughout the book. Being an African-American, the author probably has had numerous racially provoked experiences, but incessantly discussing racial profiling seems beyond the scope of this book.

Although I do agree there is unnecessary spending in medicine, frivolous expenditures occur in low, middle and high income classes. The author expresses obvious bias when he repeatedly states abuse of the system by private insurance patients, but gives little acknowledgement to the other end of the spectrum.

The author’s ultimate goal is to illustrate a broken healthcare system in the United States, and I must say that he does so successfully. I highly recommend this book to any premed or medical student, as well as to all physicians. There is a lot of information that can undoubtedly lead to better physicians throughout the country. Overall, this was a fantastic read.

Description in one word: Eye-opening

Rating: 4/5

Facts of the Day in Medicine

Here are some facts of the day:

  • Life expectancy for Americans is 78.37 years, ranking 50th among nations worldwide.
  • The US ranks only 45th in infant mortality rates, worse than many nations that are actually much poorer.
  • The US ranks #1 in healthcare expenses, spending 50% more than even the 2nd highest nation worldwide.
  • American citizens spend 2.5 times more money on healthcare than on food.
  • At current rates, healthcare costs will exceed 4.5 trillion by 2019 and if the trend continues further, account for almost 1/5 of our gross domestic product by 2025.

From How We Do Harm: A Doctor Breaks Ranks About Being Sick in America by Otis Webb Brawley, MD, with Paul Goldberg

Quotes from How We Do Harm

“Psychological and emotional support are legitimate reasons for admittance, though most insurance companies and Medicaid would disagree.”

“…an insured patient with Stage II colon cancer had better odds of being alive five years after diagnosis than an uninsured patient with what should be highly curable Stage I cancer.”

“…no incident of failure in American medicine should be dismissed as an aberration. Failure is the system, and those of us who are not yet its victims are at high risk of being sucked into its turbines.”

“When we, doctors, are at our best, we set aside our self-interest and put the patient’s interest first. When we aren’t at your best, the public pays more in fees, insurance premiums, taxes – and poor outcomes.”

“The problem is, we don’t use our expensive drugs and technologies appropriately. Instead of using these interventions to benefit patients, we use them to maximize revenues, and often harm patients.”

“Patients need to understand that more care is not better care, that doctors are not necessarily right, and that some doctors are not even truthful.”

From How We Do Harm: A Doctor Breaks Ranks About Being Sick in America by Otis Webb Brawley, M.D., with Paul Goldberg

Although I’m still reading this book, these are a few quotes that stood out to me in the first three chapters.

ObamaCare & Incentives for the Prevention of Chronic Diseases

As I’ve said previously, I’ve been extremely interested in health policies lately and have been attempting to thoroughly educate myself on the Affordable Care Act, aka ObamaCare. I found a “Fact Sheet” discussing a variety of programs for Medicaid patients that provide incentives for adopting health lifestyle choices. The grants provided must be used to address one of the following:

  • tobacco cessation
  • controlling or reducing weight
  • lowering cholesterol
  • lowering blood pressure
  • diabetes prevention (or improved management for diabetics)

The success of ObamaCare is completely dependent on preventive medicine. Incentives offer the best way possible to encourage patients to choose healthy lifestyles, so I am completely supportive of these programs. However, I think some of the incentives of these programs are flawed.

For example, I read about smoking cessation programs offering money to participants for making phone calls to helplines when they feel like smoking in order to prevent relapse. Offering phone support services is great. Sometimes people just need someone to talk to when they are having a hard time. Offering money for people to use the services is just asking to get ripped off. People can easily abuse the system, make the phone call, and then hang up and smoke their cigarette anyway.

I won’t go into details about every program I disagree with, but I think there are some characteristics that a program must possess in order to be successful.

  1. A long-term,  incentive.
    • Obviously, this entire post is about incentives. However, I think the most effective incentives are long-term incentives. What I mean by this is an incentive that is rewarded after extended periods of success (i.e. annually).
      • Example(s): Provide a monetary reward for smoking cessation at 3, 6, and 12-month intervals. Give a reward for yearly weight-loss at primary physician checkups.
      • By providing a reward after months of good behavior, the participant must dedicate themselves to the healthy lifestyle.
  2. A objective way to hold everyone accountable. 
    • A successful program must hold participants accountable. Unfortunately, the game of life isn’t always honest so there’s no reason to think patients are always honest either. Obviously, objective measures for certain healthy choices are easier than others (weight less can be measured on a scale whereas smoking cessation isn’t quite to easy), but an effective way to hold participants accountable keeps everyone honest.
      • Example: I think this needs to be approached in the same manner as someone would train a toddler. If the toddler is offered a reward for good behavior while the babysitter watches them, the parent doesn’t ask the toddler if they behaved well. They ask the babysitter. The toddler wants that reward so they’ll say they were good regardless. The same holds true for many (probably most) adults!
  3. A negative incentive. 
    • In the most basic terms, charge higher premiums for unhealthy lifestyle choices. This is a well-known idea for insurance companies with regards to smoking cessation. However, I think it should apply to other lifestyle choices as well such as obesity, hypertension, etc. Everyone can agree that the US is overweight compared to other nations, and something needs to encourage healthier lifestyles sooner rather than later.
      • This is easy to do with people who pay for insurance, but presents more of a problem for less fortunate patients who are unable to afford healthcare to begin with. Perhaps charging those below the federal poverty level a small fee based on their yearly income would encourage them to live a healthy lifestyle or maybe alternative ideas could be developed.
      • I don’t know the answer to creating a negative incentive for people who can’t afford it, but like I said, the success of ObamaCare is dependent on preventive medicine and studies show that Medicaid patients are typically at higher health risks than private insurance participants.

I decided to post this without much thought, so hopefully my thoughts are at least mostly complete.

Feel free to comment with your own opinions. I always enjoy hearing what others think.

United States Healthcare Expenses Compared to Other Countries

I like to stay well informed about debate-worthy issues, so I’ve been reading up on health policy lately. One statistic that has always struck a cord with me and did so within the first few pages of Health Policy Issues: An Economic Perspective by Paul J. Feldstein is the United States gross domestic product (GDP) spent on healthcare. A quick Google search led me to this article stating that the U.S. spends $8,233 per person each year. For most people, that doesn’t seem like a big deal right? Well, that’s actually more than 2.5 times the expenses of most other developed nations globally.

The U.S. currently spends 17.6% of GDP on healthcare costs. That’s over 17 cents per dollar spent going towards health costs. In comparison, medical services consisted of only 6% of our GDP in 1965. Even more recently, it was only 16% in 2005. Obviously, if this increasing trend continues we could be in trouble.

Although the U.S. is recognized for healthcare excellence, the Organiztion for Economic Co-operation and Development (OECD) has presented some statistics that make the U.S. system seem a little less profound. For example, in comparison to many other nations that are members of the OECD, the United States has less physicians per person, less hospital beds per person, and lower life expediencies than many other nations.

I’m not bashing the United States system and it has obvious benefits as well. As stated in the article, it leads the world in research, as well as cancer treatment. There are many more details discussed within the article so feel free to take a look. I simply wanted to spend a moment to bring to light the rising costs of healthcare in the United States. A quick glance at the chart shown pretty much says it all.

Innovative Healthcare – Real-Time Patient Monitoring After Discharge

A company known as Health Recovery Solutions (HRS) is on the rise and in my opinion, it should benefit everyone. The primary goal of HRS is simple: to reduce patient readmission to hospitals. How will it do this?

Tablets.

And I’m not talking about any medication tablets either. HRS provides hospitals with electronic tablets, which are given to patients at risk for readmission upon discharge from the hospital. The benefits of using the devices include:

  1. The devices contain educational videos, as well as quizzes following each video. Patient performance allows hospital staff to determine quantitatively determine that patient’s educational needs. 
  2. Patients use the tablet at home to record medications, weight, activities, etc. This information is then transmitted back to the healthcare facility so the patient’s healthcare providers can monitor their progress. 

Thus far, out of all the patients to receive the tablet upon discharge, not one has been readmitted to the hospital. According to the HRS website, the tablets use “a research based platform (PatientConnect) that constructively guides patents’ behaviors” and will help hospitals to “improve patient satisfaction, increase efficiency of their workflow, and generate additional revenue”.

What could make this software even more beneficial in the future?

The Affordable Care Act, also known as Obamacare, hopes to reduce hospital readmission as well. According to an article on CNN Money, HRS is one of several companies that should benefit from the institution of Obamacare. To reduce patient readmission rates, Obamacare institutes a penalty for hospitals that fail to meet criteria:

  • Any Medicare patient treated for pneumonia, heart failure, or a heart attack that requires readmission to the hospital within 30 days of original discharge will result in a 1% reduction in Medicare reimbursements for that hospital.

Obviously, if HRS can continue to prove their worth, the tablet concept would prove paramount in avoiding patient readmission penalties. As stated previously, HRS claims that healthcare facilities can actually increase their revenue by using the tablet platform. Only time will tell. Regardless of the effects on Health Recovery Solutions due to Obamacare, the company has employed an innovative idea that should benefits patients and healthcare professionals.

What might be a problem? 

Despite my fascination with this concept, I just don’t see how it can work in a facility that serves the underprivileged population. The main reason that comes to mind is cost. This wouldn’t be as large of an issue if the hospital can truly make money by implementing this system. If it does cost the hospital money, institutions that are already hard-pressed to obtain adequate funding will be unable to use it. Furthermore, many of the patients treated in these facilities are living below the national poverty level, oftentimes homeless or unemployed. Giving out tablets to everyone and expecting to get them all back is simply unrealistic. You can charge fees to prevent the wealthy from breaking, losing or stealing, but the undeserved population wouldn’t be able to pay the fee anyway. Would the hospital or insurance company cover it then? Someone has to pay the bill, because you know HRS isn’t going to turn into a company that gives away free tablets. 

Conclusion

As long as hospitals are able to meet the financial obligations, HRS could have extremely beneficial effects on the healthcare system. I think real-time patient monitoring after discharge is one of the next innovative steps in healthcare. A foundational component of Obamacare being successful is preventative medicine. Preventing readmission through post-discharge monitoring systems is an excellent method for preventing post-treatment complications and increasing positive patient outcomes.

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