Original commentary by BEI Young Professionals Charley Willison.
In order to achieve and maintain good health, utilization and access to healthcare services is a key necessity (Sade, 1430.) Healthcare can prevent or ameliorate disease and disability, providing the potential to cure and repair damage to important physiological functions and improving quality of life (1430). The World Health Organization defines health as an inherent right of all people, defining healthcare as a necessary component of attaining health (WHO, 2012). Providing access to healthcare for all people is supported by social contract theory. As John Rawls said, underneath the veil of ignorance all persons would want access to the same basic necessities and rights (Thrasher). Thus, all people have an equal opportunity to realize the goal of maintaining health and their improving quality of life (Thrasher).
To realize the goal of an equal opportunity for health, the imminent need for accessible healthcare must be addressed immediately. Managing systematic problems of quality, cost and access within our healthcare system can only occur through substantial healthcare reforms and improvement. The passage of the Patient Protection and Affordable Care Act, the most significant healthcare reform in the history of American healthcare since Medicare/Medicaid in 1965, (Rovner) is a path down the road to solving the serious inequity in American healthcare. The deep inequities that we carry as a nation emphasize the need for implementation of the provisions of the PPACA, and further healthcare reform and quality improvement in the future.
The United States has long been known for its inequitable healthcare system, with high-costs and less than impressive health outcomes (Frontline). Rising healthcare costs, barriers to accessing medical care, and problems of quality and efficiency have been highlighted as reasons for reform. At the time of the enactment of the Patient Protection and Affordable Care Act, the U.S. was spending nearly 1/5 of its GDP on healthcare costs (HealthPAC). This exorbitant amount makes the U.S. the most expensive healthcare system in the world, spending almost twice what any other industrialized nation spends on healthcare (WHO 2012). However, just because a lot of money is spent on healthcare does not equate to a healthier population. In its 2000 assessment, the WHO ranked the United States 37th healthiest nation out of all nations in the world, behind Costa Rica (2012). Compared to other industrialized nations including The Netherlands and Germay, the U.S. ranks last on infant mortality rates, and deaths before age 75 (Mahon).
Of nations in the developed world, Americans have the hardest time accessing medical care, (Mahon). Nearly 50 million Americans are uninsured, with a whopping additional 40 million underinsured (HealthPAC). Underinsured refers to insured individuals who are unable to access all of the medical care they may need due to cost (HealthPAC). In America, 54% of individuals with a chronic medical condition reported being unable to afford recommended treatments/tests (Mahon). In the Netherlands, which ranks as one of the top healthcare systems in the world, only 7% of patients with chronic conditions reported challenges in accessing care due to cost constraints (Mahon). Patients with chronic conditions in the U.S. may also face access issues due to coverage discrimination (May, 572). Until the provisions of the PPACA take effect in 2014, it is still legal for individuals with chronic medical conditions to be discriminated against and either denied insurance coverage because of a pre-existing condition or charged higher premiums (572).
When evaluating measures of quality, the United States ranks near the bottom compared to other industrialized nations (Mahon). The current fee-for-service system that has been the model of care in the U.S for decades is not effective. Thus, there has been much discussion among healthcare reformists to move away from that model in favor of something else. Under the fee-for-service system, providers are paid for procedures they perform rather than the good outcomes that may be achieved (May, 572). Not surprisingly, the U.S. ranks last in patient safety and next to last for coordinated care. Patients with chronic medical conditions are the most likely to report being given the wrong medication or the wrong dose of their medication, as well as to experience delayed notification of abnormal test results (Mahon).
The United States ranks near the bottom of the list for measures of efficiency; being able to deliver care in the most resourceful and timely manner (Mahon). The medical system focuses on treating acute conditions, with a lack of emphasis on preventative medicine, making the United States extremely inefficient in preventing disease and disability (May, 572). Administrative costs burden the system, leading to long waiting times and poorly managed care, particularly for chronic medical conditions (Mahon). Poor-management and a lack of coordinated care has lead to high rates of re-hospitalization and duplicative testing (Mahon). Of American adults with chronic conditions, nineteen percent reported visiting an Emergency Department for a condition that could have been treated by a ‘regular doctor’ if one had been available. This rate is more than three times that of patients in Germany or the Netherlands (Mahon).
The serious inequity of the American healthcare system is a horrible reality, and has prompted substantial reform. The people of America should have the right to affordable, quality, efficient healthcare. As the provisions of the PPACA come into effect, we begin to see the power and importance of healthcare reform as a driver of societal change, and for the promise of realizing health and the maintenance of health. We, as a nation, must continue to fight to uphold the components of the PPACA, to protect the rights and lives of our fellow Americans.
Frontline, PBS. Sick Around the World. April 15, 2008. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/. April 30, 2012.
HealthPAConline. Health Care Statistics in the United States. 2012. http://www.healthpaconline.net/health-care-statistics-in-the-united- states.htm. 11/25/2012.
Mahon, Mary. U.S. Ranks Last Among Seven Countries on Health System Performance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives; Affordable Care Act Holds Promise for U.S. Performance; Focus on Information Technology and Primary Care Vital To Achieving High Performance. The Commonwealth Fund. June 23, 2010. http://www.commonwealthfund.org/News/News-Releases/2010/Jun/US- Ranks-Last-Among-Seven-Countries.aspx. 11/26/2012.
May, William. The ethical foundations of health care reform. Christian Century. June 1, 1994. 111(18). 572-576. 11/11/2012.
Rovner, Julie. Congress Doing Healthcare the Hard Way. National Public Radio. 01/06/2010. http://www.npr.org/templates/story/story.php?storyId=122271679. 11/27/2012.
Sade, Robert M. Ethical Foundations of Health Care System Reform Annals of Thoracic Surgery. 2007. 84. 1429–31.
Thrasher, John and Gerald Gaus. Contemporary Approaches to the Social Contract. 12/20/ 2011. http://plato.stanford.edu/entries/contractarianism- contemporary/. 12/01/2012.
World Health Organization. Health Systems: Improving Performance. The World Health Report 2000. http://www.who.int/mediacentre/factsheets/fs323/en/index.html. 11/22/2012.