The healthcare system in the U.S. is complex and fragmented. The industry has changed quite a bit over the years with some amazing advancements that have improved the industry (e.g., technology to diagnose and treat disease, gender, and race are no longer invisible barriers to training, among many others). Some changes present significant challenges and offer less utility (e.g., cost of care, complex payer systems, limited societal access to care).
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First Memories of Medicine
My first memorable experience with our healthcare system was a trip to the hospital for an injured rib as a 12-year old playing in an extremely intense backyard Wiffle Ball game (i.e., we apparently didn’t know the rules). After calling my mother at the hospital, she worked as a nurse’s aide at Central Baptist Hospital, she asked an orthopedic physician what we should do. He took the phone and told me to come in for an X-ray, never asking how I would get there. I said okay and rode my bike to the hospital. It was not a short distance nor a pleasurable experience. Upon arrival, I was ushered up to the orthopedic floor and X-rays were taken. No paperwork, nothing. The picture revealed no break. I was told my rib was bruised, and it would hurt for a while. That was a very accurate prediction and would not be the last time I damaged my ribs! Except for the X-rays, there was no charge. I assume we had to pay for the film, but there was no mention of it. I left the hospital for home…oh yes, on my bike.
That same injury today would likely require a caregiver leaving work for a trip to the emergency department (ED) at a nearby hospital. The healthcare system dance begins at the ED for those not in immediate peril. It starts with insurance confirmation, assessment of condition, deductible, payment options, followed by long wait, x-rays, reading the x-rays, prescription for pain medicine, discharge, and thousands of dollars in cost, once the charges are all figured out.
Current Challenges
Challenges to our current healthcare access seems overwhelming. Cost of care, provider availability, geographic barriers, health literacy, compounded by an aging population are but a few of the hurdles facing our healthcare system. Individuals who are un- or underinsured routinely face high-deductibles and out-of-pocket costs that force them to forgo preventive and sometimes necessary care. Healthcare is fragmented, complex, and difficult to navigate without help. A growing concern is provider availability, which is particularly alarming in underserved and marginalized communities. The list of challenges to our system in the US seems insurmountable.
Challenges facing healthcare delivery today are more complicated than ever and will require comprehensive effort and cooperation across many levels of society. To-date, competing industry, societal, and political interests have shown up more as impediments than avenues to achieving the cooperation needed.
Is there an answer?
