The Nightmare of Healthcare

Why is health care so expensive? Before today, I was clueless. I don’t mean that I didn’t know the basics: prices are climbing, debates are ensuing, people are unhappy—but I never knew the details or extent of the problem.

The United States spends twice as much as other wealthy nations on healthcare. At first, I thought this money seemed like a worthy investment, but then I learned that Americans may not be getting their money’s worth. The United States lags behind other nations (who spend less) in measures such as infant mortality and life expectancy (1). In 2000, the World Health Organization ranked United States health care as highest in cost, 37th in overall performance, and 72nd in overall level of health. There were 191 nations in the study (2). Furthermore, at least 15% of Americans are uninsured, and a considerable additional portion is “underinsured.” The Institute of Medicine of the National Academy of Sciences describes the somewhat embarrassing problem: “The United States is the only wealthy, industrialized nation that does not ensure that all citizens have coverage” (3). All in all, the total number of Americans who die each year because of lack of medical care exceeds 100,000.

How can America simultaneously reduce costs and improve the quality of healthcare? After perusing the Internet for about 30 seconds, I realized that this question does not have a simple answer. Americans seem to blame everyone and everything for the problem. Some claims are reasonable while others are outrageous, and basically nobody agrees upon a solution. Sometimes I don’t even know who to believe! The problem is multi-faceted: I guess this is a good opportunity for me to “think like an engineer.”

I soon learned that one contributor to the health care crisis is delay in seeking medical care. Uninsured Americans are more likely to postpone a visit to the doctor; but in the long run, such a delay can cause more medical problems, which tend to be more expensive to treat than ongoing issues (4). If simple office visits were more affordable and easier to schedule, such long-term conditions could be partly avoided. Perhaps patients could even meet with a nurse, rather than a doctor—could such a system save money?

Problems with care coordination also account for extra costs. About one in five doctors reported having patients retake tests because the results have been misplaced (5). Diagnostic tests tend to be very pricey; creating a more efficient system for filing results seems like a worthwhile investment. Another clerical problem results from different types of record keeping. I worked in my dad’s office over the summer—he is a physician—and saw firsthand how mixing paper and electronic records creates confusion and extra work. Implementing Electronics Medical Records (EMR) can save time and money and eliminate confusion, making patient care more seamless (6).

Sometimes disease prevention can be very cost effective. For every $1 spent in water fluoridation, $38 is saved in dental restorative treatments costs. Implementing an Arthritis Self-Help Course among 10,000 people lowers health costs by $2.5 million, while also reducing pain by 18%. Clinical smoking interventions cost about $2587 for each year of life saved—the most cost effective of all clinical health services. Similarly, a mammogram every couple years for women aged 50-69 costs about $9000 a year per life saved. All these measures reduce medical costs in the long run (7).

But I think the most interesting way to reduce healthcare costs is personalized medicine. Personalized medicine can determine someone’s predisposition to a certain disease. The cost of individualized treatments and diagnostic tests may be more expensive, but in the end, the tests may help people avoid more costly treatments (8).

So which of these measures will best help reduce health care costs? To be honest, I have no idea. I am afraid that some of the sources I used are biased. For example, one overwhelmingly conservative source places an entire argument around how the uninsured are “jacking up” emergency room prices, which ruins our health care system. Maybe there is some truth in his claim, but the argument seemed too one-sided to me. Another article I read blames healthcare prices on obesity. “One of the reasons that healthcare is so expensive is that we are fat,” the article begins (9). The website continues to discuss how obesity is “killing us.” Again, the article struck me as trying to pinpoint one specific cause of a multi-faceted problem. Everybody needs something to blame—a scapegoat— to explain away the healthcare crisis. But there is no one cause, nor is there one solution, to the problem.

Sources
1. Marian F MacDorman, Ph.D., and T.J. Mathews, M.S.. "Recent Trends in Infant Mortality in the United States" (pdf). National Center for Health Statistics, Centers for Disease Control.
2. World Health Organization assess the world's health system. Press Release WHO/44 21 June 2000.
3. Insuring America's Health: Principles and Recommendations, Institute of Medicine of the National Academies of Science, 2004-01-14. Retrieved 2007-10-22.
4. Hadley, Jack, "Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition", JAMA, March 14, 2007; 297: 1073 - 1084.
5. California HealthCare Foundation, [4] "Uncoordinated Care: A Survey of Physician and Patient Experience"], Harris Interactive. 2007. Retrieved March 20, 2008.
6. http://knowledge.emory.edu/article.cfm?articleid=1263
7. http://nextbigfuture.com/2009/06/best-ways-to-lower-healthcare-costs-by.html
8. Lesko L (2007) "Personalized medicine: elusive dream or imminent reality?" Clin Pharmacol Ther 81 (6) pp. 807-16.
9. http://www.whereistheoutrage.net/wordpress/2009/09/19/why-is-healthcare-so-expensive/comment-page-1/