1.What do you think is the biggest challenge with the United States healthcaresystem - and if you were in charge, how would you address it?
Oneof the greatest challenges in US health care system today is also a veryhot-topic: access for all to health services. I am both excited andhopeful to see more Americans than ever before actively debating health care asa human right. Our deep roots in rugged individualism along with the for-profitfoundations of our health care system have deferred universal health care forAmericans for many decades in comparison to our counterparts in Canada andBritain who have had such systems in place for nearly 70 years.
Thegate-keeper to access for all, of course, is financing. Ironically,the Canadian and UK health care systems have health care financing hoveringaround 10% of GDP, while the US financing for health care is around 15% of GDPand climbing. Yet overall, Americans see doctors less often and find thatcost is a significant barrier to accessing services, compared to manycountries. We pay 1- 3 times more per capita than most countries, and ourspending on pharmaceutical costs are 30%- 60% higher than most countries.*
If Iwere to influence changes in the American health care system I would start withprice controls in the pharmaceutical industry. I would examine insurancecompany regulations to promote American’s access to services and considerlimits on the health care industry’s profit margins. There are some fairlyeffective health care systems in countries such as Canada and the UK. It wouldbe worthwhile to explore how those systems might be adapted to the Americancontext.
Inparallel, I would undertake an initiative to raise American's awareness ofalternative health care models and about what many Europeans and Canadians havein terms of services and quality of care that Americans do not. This wouldequip Americans to advocate for improvements in our system of healthcare. There is no simple solution, but we do not have to reinvent thewheel. We could learn from those health care systems that have a successfultrack record.
*Source:OECD Health care data 2015.
2.In your experience, what are the 3 biggest challenges you see people face whenseeking healthcare or navigating the healthcare system?
Thethree major challenges patients and their families face are (1) an overlycomplicated healthcare system, (2) difficulty accessing the system with asudden onset of illness and (3) overall access for those who are notinsured. Seeking the appropriate care can be overwhelming for mostAmericans, especially when sick or facing the illness of a loved one.
Healthcare in the US means working with numerous health care entities from insurancecompanies and specialized doctors and practices, to various diagnostic andtreatment facilities. You need to work with insurance premiums, co-paysand limited coverage, while also working with many doctors (or medical teamsfor more serious illnesses). Unfortunately they are not always in sync. Even diagnostic and provider advice can be in conflict, and determining one’streatment plan can be very challenging. Patients need to be their ownadvocate to access various specialists and diagnostics, and this can bedifficult to juggle with work and other daily competing priorities.
Forsudden acute issues, entry into the health care system can be difficultespecially after hours for urgent non-emergency issues. Often patientsmust go to emergency rooms with long waiting times in order to get the carethey need on weekends on in the middle of the night when a high fever spikes ora chronic illness becomes more acute.
Whilethe Affordable Care Act is extending more coverage to folks, sadly manyAmericans have experienced a lack of coverage over their lifetime. That can benot only be scary, but may also affect one’s life choices such as work or evenmarriage.
3.Please share an experience that you or an associate has had navigating thehealthcare system that opened your eyes to a need for a better process orbetter information.
Myfather suffers from diabetes and he has been fighting a life-threatening MercerStaph infection (acquired from a previous surgery in a local hospital) for overa decade. This past year, my Dad needed further surgery to repairhis ankle, and unfortunately the Staph infection had advanced to the pointwhere he needed surgery daily to try to avoid sepsis. His infectionadvanced because his remote follow up care failed to recognize thesymptoms.
Oncehe was in a critical care unit of a leading teaching hospital, my Dad did notunderstand the difference between the many medical teams that were visitinghim. There were numerous interns and specialists dealing with various aspectsof his medical issues, as well as dozens of medical students, residents, andfellows making rounds to witness this advanced Mercer staph infection. Often,they would give him conflicting advice and recommendations.
Moreover,while the best course of treatment given the advanced Mercer Staph infectionand threat of sepsis was amputation, all of the medical staff avoideddiscussing it. As his daughter and patient advocate, the burden was on meto raise the topic and convince my Dad that this was not giving-up, but wasfighting for his life.
Ithink most Americans struggle with decisions around the end of life andchoosing less invasive or less rigorous medical treatments, as they areencouraged to take on very ambitious and highly medicalized treatments in oursystem.
Mydad is now thriving and has a new lease on life where he is more mobilewalking, hiking and swimming, and his long road of suffering has finallyended. I think there is so much more the health system can do to preventsuffering, preserve dignity and help Americans to make major decisions earlierin their disease stage.
4. Theyear is 2040: how will healthcare have changed? What will be the biggestinnovation? Who will win, and who will lose, in this scenario?
Intwenty years, I think that technology can revolutionize health care managementin so many ways to promote patient rights and quality of care. Technologycould solve issues around health records so that patient's records areaccessible to health care providers not only in the US, but globally. Inan emergency, doctors anywhere should be able to access patient histories andutilize this critical information to rapidly and more accurately diagnose andtreat urgent medical issues.
Technologycould also facilitate health service transparency, shedding light not only onhealth care costs but also on quality of care by provider and health facility.This would enable patients to more easily navigate the US health care systemand make informed choices around the services they seek. Imagine patientfriendly dashboards showing performance indicators for each doctor, such asnumber of a particular kind of surgery and the morbidity and mortalitystatistics associated with various facilities.
Ialso hope that we see greater investments in public health and prevention, asincreasing evidence shows that patient management and prevention of chronicdiseases are significant levers to controlling costs in the health caresystem. In this case, I see patients, and high performing doctors andfacilities as winners.
5.What single service, innovation or entity exists in United States healthcarethat makes us the envy of the world? What would you point to as proof that ourhealthcare system may be flawed, but is still world class?
Inthe US, we may not have conquered universal health coverage for all, but wealso do not limit access to the most cutting edge medical treatments, if youcan afford it. In any given hospital around the country you can sign-up formedical research studies, participate in drug trials and have access to thelatest technologies and treatments even before they are availableglobally.
Wealso have some of the highest caliber doctors in the world, where they havespent their entire careers dedicated to one specialization. If you have aspecific issue, you have a chance of being treated by the foremost expert inthat area. Our doctors are often conducting research and gainingspecialized experience in particular disease areas. They are pushing theboundaries on life expectancy for many diseases that our grandparents died fromjust a few decades ago. Therefore, access to life-saving technologies andtreatments is within grasp for many individuals, and that is an important rolethat the US plays not only for Americans, but for people all over theworld.
About Dr. Waller:
KimberlyWaller, PhD, MPH is an international development professional with over 22years of experience in health care program management in fivecontinents. She works to improve access to, and quality of, healthservices for marginalized populations, mainly promoting maternal and childhealth, women’s health and better health for youth. Dr. Waller workswith Ministers of Health, Federal and State level Health officials, Health CareAdministrators and health care facilities in the public and private sectors. Withrecent changes in the US Administration and a greater focus on the US healthcare system, Dr. Waller is returning home to focus on domestic health care.
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