1. What do you think is the biggest challenge with the United States healthcare system - and if you were in charge, how would you address it?

One of the greatest challenges in US health care system today is also a very hot-topic: access for all to health services.  I am both excited and hopeful to see more Americans than ever before actively debating health care as a human right. Our deep roots in rugged individualism along with the for-profit foundations of our health care system have deferred universal health care for Americans for many decades in comparison to our counterparts in Canada and Britain who have had such systems in place for nearly 70 years. 

The gate-keeper to access for all, of course, is financing.  Ironically, the Canadian and UK health care systems have health care financing hovering around 10% of GDP, while the US financing for health care is around 15% of GDP and climbing.  Yet overall, Americans see doctors less often and find that cost is a significant barrier to accessing services, compared to many countries.  We pay 1- 3 times more per capita than most countries, and our spending on pharmaceutical costs are 30%- 60% higher than most countries.*

If I were to influence changes in the American health care system I would start with price controls in the pharmaceutical industry.  I would examine insurance company regulations to promote American’s access to services and consider limits on the health care industry’s profit margins. There are some fairly effective health care systems in countries such as Canada and the UK. It would be worthwhile to explore how those systems might be adapted to the American context. 

 In parallel, I would undertake an initiative to raise American's awareness of alternative health care models and about what many Europeans and Canadians have in terms of services and quality of care that Americans do not. This would equip Americans to advocate for improvements in our system of health care.  There is no simple solution, but we do not have to reinvent the wheel. We could learn from those health care systems that have a successful track record. 

 *Source: OECD Health care data 2015. 

 

2. In your experience, what are the 3 biggest challenges you see people face when seeking healthcare or navigating the healthcare system?

The three major challenges patients and their families face are (1) an overly complicated healthcare system, (2) difficulty accessing the system with a sudden onset of illness and (3) overall access for those who are not insured.  Seeking the appropriate care can be overwhelming for most Americans, especially when sick or facing the illness of a loved one. 

Health care in the US means working with numerous health care entities from insurance companies and specialized doctors and practices, to various diagnostic and treatment facilities.  You need to work with insurance premiums, co-pays and limited coverage, while also working with many doctors (or medical teams for more serious illnesses). Unfortunately they are not always in sync.  Even diagnostic and provider advice can be in conflict, and determining one’s treatment plan can be very challenging. Patients need to be their own advocate to access various specialists and diagnostics, and this can be difficult to juggle with work and other daily competing priorities. 

For sudden acute issues, entry into the health care system can be difficult especially after hours for urgent non-emergency issues.  Often patients must go to emergency rooms with long waiting times in order to get the care they need on weekends on in the middle of the night when a high fever spikes or a chronic illness becomes more acute. 

While the Affordable Care Act is extending more coverage to folks, sadly many Americans have experienced a lack of coverage over their lifetime. That can be not only be scary, but may also affect one’s life choices such as work or even marriage.

  

3. Please share an experience that you or an associate has had navigating the healthcare system that opened your eyes to a need for a better process or better information.

My father suffers from diabetes and he has been fighting a life-threatening Mercer Staph infection (acquired from a previous surgery in a local hospital) for over a decade.   This past year, my Dad needed further surgery to repair his ankle, and unfortunately the Staph infection had advanced to the point where he needed surgery daily to try to avoid sepsis.  His infection advanced because his remote follow up care failed to recognize the symptoms. 

Once he was in a critical care unit of a leading teaching hospital, my Dad did not understand the difference between the many medical teams that were visiting him. There were numerous interns and specialists dealing with various aspects of his medical issues, as well as dozens of medical students, residents, and fellows 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 infection and threat of sepsis was amputation, all of the medical staff avoided discussing it.  As his daughter and patient advocate, the burden was on me to raise the topic and convince my Dad that this was not giving-up, but was fighting for his life. 

I think most Americans struggle with decisions around the end of life and choosing less invasive or less rigorous medical treatments, as they are encouraged to take on very ambitious and highly medicalized treatments in our system. 

My dad is now thriving and has a new lease on life where he is more mobile walking, hiking and swimming, and his long road of suffering has finally ended.  I think there is so much more the health system can do to prevent suffering, preserve dignity and help Americans to make major decisions earlier in their disease stage.

  

4. The year is 2040: how will healthcare have changed? What will be the biggest innovation? Who will win, and who will lose, in this scenario?

In twenty years, I think that technology can revolutionize health care management in so many ways to promote patient rights and quality of care.  Technology could solve issues around health records so that patient's records are accessible to health care providers not only in the US, but globally.  In an emergency, doctors anywhere should be able to access patient histories and utilize this critical information to rapidly and more accurately diagnose and treat urgent medical issues. 

Technology could also facilitate health service transparency, shedding light not only on health 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 system and make informed choices around the services they seek.  Imagine patient friendly dashboards showing performance indicators for each doctor, such as number of a particular kind of surgery and the morbidity and mortality statistics associated with various facilities.

I also hope that we see greater investments in public health and prevention, as increasing evidence shows that patient management and prevention of chronic diseases are significant levers to controlling costs in the health care system.  In this case, I see patients, and high performing doctors and facilities as winners.

 

5. What single service, innovation or entity exists in United States healthcare that makes us the envy of the world? What would you point to as proof that our healthcare system may be flawed, but is still world class?

 In the US, we may not have conquered universal health coverage for all, but we also do not limit access to the most cutting edge medical treatments, if you can afford it.  In any given hospital around the country you can sign-up for medical research studies, participate in drug trials and have access to the latest technologies and treatments even before they are available globally. 

We also have some of the highest caliber doctors in the world, where they have spent their entire careers dedicated to one specialization. If you have a specific issue, you have a chance of being treated by the foremost expert in that area.  Our doctors are often conducting research and gaining specialized experience in particular disease areas. They are pushing the boundaries on life expectancy for many diseases that our grandparents died from just a few decades ago.  Therefore, access to life-saving technologies and treatments is within grasp for many individuals, and that is an important role that the US plays not only for Americans, but for people all over the world. 

 

About Dr. Waller:

Kimberly Waller, PhD, MPH is an international development professional with over 22 years of experience in health care program management in five continents.  She works to improve access to, and quality of, health services for marginalized populations, mainly promoting maternal and child health, women’s health and better health for youth.  Dr. Waller works with Ministers of Health, Federal and State level Health officials, Health Care Administrators and health care facilities in the public and private sectors.  With recent changes in the US Administration and a greater focus on the US health care system, Dr. Waller is returning home to focus on domestic health care.