On the eve of the presidential election, I'm going to step outside my box and talk for a moment about several major healthcare trends that can no longer go unnoticed. The first is the trend towards longevity. Another is the trend in unbridled healthcare spending. Still another is the continuing trend in specialization by a disproportionate number of physicians.
While longevity has been extended by improved nutrition over the decades, advancements in technology, and victory in the battle against infectious illnesses, it is accompanied by an ever graying population living with multiple chronic illnesses and conditions. Half of all Americans today have one or more chronic conditions (Foundation for Accountability, 2001).
The Robert Woods Johnson Foundation (1996) reports chronic conditions and illnesses are believed to account for three out of every four deaths in this country....and reportedly an equivalent share of healthcare spending. Yet the U.S. healthcare system is criticized for being still largely designed to respond to acute illnesses, failing to meet the full needs of people in such situations (Hoffman et al., 1996). Moreover, the role of the community hospital has yet to be defined in this context nor put into gear strategically for its future calling. Other sectors fall woefully short, including the public health education system as a resource to patients and caregivers.
The second trend of unbridled spending - today at $2 trillion and nearly 20% of the nation's GNP - still leaves millions uninsured and countless others disenfranchised. Our embarrassingly low health literacy rate - one fifth of the populace - prevents individuals from being equipped to manage self-care decisions and strips them of quality of life choices. Despite our spending, the U.S. fails to rank among the top ten nations worldwide in terms of quality of care, even by the most generous of yardsticks. We have no guiding policy to direct the management of two significant contributors to the tab: an aging population and one that is increasingly obese and unfit.
It has been statistically demonstrated in other developed countries that higher levels of primary care professionals are associated with lower overall mortality and lower death rates due to diseases of the heart and cancer (Shi 1992). Yet we continue to allow incentives that push doctors in the specialties and sub-specialties, encouraging maldistribution of all practitioners geographically. Instead we gaze at other countries whose health systems are more oriented to primary care achieve higher health status among their populaces, higher consumer satisfaction with health services, lower expenditures in the delivery of care, and earlier intervention in preventable illnesses and conditions.
When you vote in November, think about the candidates who will help get this nation on a prudent and strategic course that eliminates barriers to access, rewards rather than penalizes longevity, wisely contains spending by investing in technology that delivers improved efficiency and safety where it counts most, and boosting primary care coverage of all Americans.
Published On: September 02, 2008