After volunteering in the emergency department of a county hospital for several months, I realized how difficult it is for physicians to truly fix medical issues rooted in socioeconomic inequality.
A flow of patients would enter the ED with various conditions. Nearly every minute, a slew of blood tests, ultrasounds, and various other modalities were charged to patients. While some patients could afford this expensive quality care, it was obvious that many patients were from economically disparaged backgrounds. Those who had health insurance would likely have to pay a small fraction of the cost, but now that they had become a “higher risk,” their health insurance premiums would also likely rise. Those who didn’t have health insurance had to pay out of pocket. Some couldn’t even do that — this cost was billed to the government.
As the Republican Party proceeds to vote on healthcare reform, the attention of healthcare policy has shifted away from the people who utilize these laws daily to bill patients (i.e. hospital administrators and physicians) to those who sit in chair in Washington D.C. While certainly the Affordable Care Act (ACA) has made cost of healthcare more affordable to millions of Americans, insurance companies continue to set high premiums. This issue is exacerbated when the focus of “the cost of care” is insurance-dependent. When policy makers refer to the “cost of care,” they typically mean what the government or insurers pay to providers (i.e. hospitals and physicians), whereas providers typically measure the cost based on reimbursement. But the “cost of care” does not accurately represent the actual cost of the resources and procedures used, which is rising dramatically.
Virtually devoid of this discussion is the responsibility that physicians and public health experts have. While certainly policy makers bear the brunt of responsibility, the media coverage shouldn’t remove physicians and hospital administration from responsibility.
Ultimately, higher healthcare expenditure isn’t associated positively with better access to healthcare or the physicians’ ability to provide high quality care. To illustrate this point, a 2008 comparative study from Dartmouth College’s Brenda Sirovich compared physicians in cities with low costs of care and high costs of care. Physicians in cities with low costs of care typically called patients back less and utilized many less tests to confirm their diagnosis when compared to their higher-spending region counterparts. They did this without compromising the quality of care.
Remarkably, this illustrates the potential for tremendous waste in our healthcare system. A study by Donald Berwick at Harvard University in 2012, showed that nearly 14 percent of total waste is clinical waste, which could be prevented largely from standardizing efficient practices and replacing costly services with less-resource-intensive alternatives.
Most of the peer-reviewed literature presented about the real cost of care provides clear evidence that there is tremendous waste in the healthcare system. Nearly $1 trillion, by some estimates.
Much of it presents itself in the hospital — how a physician prescribes medication or approaches the medical condition all influence the issue of cost. Neglecting this discussion in the media diverts the attention from the tangible actions that physicians can and should be taking to shady politics that may or may not ever manifest into tangible changes for the general public.
