Expert Recommendations for Fixing the US Health Care System
· Eliminate for-profit institutions from US health care.
o Put an end to profiteering by providers (e.g. Steward Health Care)
· Stop the for-profit acquisitions of primary care physician practices.
· Stop hospital consolidations leading to monopolistic and oligopolistic price gouging
· Build up primary care practitioners, their compensation and responsibilities
o Shift compensation and responsibilities from over reliance on specialists towards primary care
· Shift away from fee for service reimbursement towards alternative payment methodologies focused on improving patient outcomes
o Expand pay for performance reimbursement
· Build up and integrate public health
· Regulate/negotiate prices for prescription drugs
· Reduce administrative complexity
o Standardize plan coverage
· Reduce and standardize copays and deductibles
o Cap patient out of pocket as a percentage of income
o Make coverage and care affordable to everyday working Americans (1/4th of people with coverage cannot afford their copays and deductibles); repair employment-based coverage; fix bronze and copper coverage in the Exchanges
· Deploy technological advances (AI, remote patient monitoring, wearable health technology, genomics) to improve outcomes and reduce costs
o Expand the use of telehealth
o Expand the use of AI
o Expand the use of robotics
o Shift more care from large costly institutional settings towards homes and communities
· Provide more patient care access to working people on weekends and evenings
· Make hospitals more energy efficient and weather resilient
· Prioritize patient education and disease prevention
· Strengthen medical supply chains
· Strengthen and update medical ethics to keep current with today’s challenges
· Increase the use of patient centered medical homes for those with costly chronic illnesses
· Learn and adopt policies and practices from the best performing nations
o Australia, Netherlands and UK ranked 1,2,3 while US ranked a sorry and far distant last of the 10 nations measured and surveyed
§ Access
· Low or no copays
· Capped out of pocket responsibilities
· After hours and weekend availability for primary care
· Coverage for the uninsured
§ Care Process (US now ranks #2 due to Pay for Performance reimbursement incentives)
· Preventive services
· Patient safety
· Continuity of patient care
§ Administrative efficiency (Australia and UK rank highest, US is dismal and costly last)
· Timely processing and payments for services rendered (nearly instantaneous in Australia)
· US has thousands of plans with endless variations; denials are common, and then must be appealed.
· Burdens of administration fall heavily on US patients and their providers
§ Equity refers to differences in access and treatment of lower income and upper income patients
· Australia, UK and Germany are the best; US is very bad
· This is primarily because all have access to a primary care doc and because copays and deductibles are not barriers to care access for lower income patients
· Adding in measurements for geographic (urban v, rural) and gender access moves Switzerland up to the top
§ Health outcomes refer to life expectancy, preventable deaths and excess deaths due to Covid
· Australia and Switzerland rank highest; US is last and very far behind.
· This is a combination of much lower (4 years) life expectancy, much higher drug and gun deaths
References:
https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
https://www.pgpf.org/article/how-does-the-us-healthcare-system-compare-to-other-countries/