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  • 2018-02-23 19:23:37
  • by Cheryl Stephens (talk | contribs)
  • Note: Additional information about Canada
 
   
Title Title
Why American healthcare is so expensive Why American healthcare is so expensive
Summary Summary
Answer a community member's question on the U.S. healthcare system - why it costs so much despite Americans being so unhealthy Answer a community member's question on the U.S. healthcare system - why it costs so much despite Americans being so unhealthy
Highlights Highlights
One thing the U.S. system has in common with single-payer model, most patients don’t worry about cost of medical treatment , U.S. system incentivizes providers to overcharge , Not all U.S. health issues blamed on dysfunctional healthcare system One thing the U.S. system has in common with single-payer model, most patients don’t worry about cost of medical treatment , U.S. system incentivizes providers to overcharge , Not all U.S. health issues blamed on dysfunctional healthcare system
Content Content
<em>Help report on the U.S. healthcare system by going to EDIT STORY, or offer a suggestion in TALK. </em> <em>Help report on the U.S. healthcare system by going to EDIT STORY, or offer a suggestion in TALK. </em>
<strong>Community member <a href="https://www.wikitribune.com/user/donald-boone/">Donald Boone</a> asked: </strong><strong>Why are healthcare outcomes in other industrialized countries better than in the United States, even though the cost of healthcare in other countries is typically lower than in the United States?</strong> <strong>Community member <a href="https://www.wikitribune.com/user/donald-boone/">Donald Boone</a> asked: </strong><strong>Why are healthcare outcomes in other industrialized countries better than in the United States, even though the cost of healthcare in other countries is typically lower than in the United States?</strong>
To answer this question, we need to focus on why healthcare in the United States is so expensive, and then understand how this ends with people being less healthy as a result. To answer this question, we need to focus on why healthcare in the United States is so expensive, and then understand how this ends with people being less healthy as a result.
The United States spent<a href="https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf"> $3.3 trillion on healthcare</a> in 2016. That’s more than $10,000 per person, according to the Center for Medicare Studies. By comparison, Canada <a href="https://www.cihi.ca/en/health-spending">spends roughly $6,600</a> per person <em>(C</em><i>anadian Institute of Health Information). </i> The United States spent<a href="https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf"> $3.3 trillion on healthcare</a> in 2016. That’s more than $10,000 per person, according to the Center for Medicare Studies. By comparison, Canada <a href="https://www.cihi.ca/en/health-spending">spends roughly $6,600</a> per person <em>(C</em><i>anadian Institute of Health Information). </i>
<span style="font-weight: 400">This discrepancy in cost is driven by two factors: how prices are set, and how medical bills are paid. In countries such as Canada with "single-payer" systems, this process works simply. The </span><a href="http://www.businessinsider.com/us-single-payer-debate-comparisons-to-canada-uk-germany-2017-6"><span style="font-weight: 400">government sets the price</span></a><span style="font-weight: 400"> for a medical procedure </span><i><span style="font-weight: 400">(Business Insider)</span></i><span style="font-weight: 400">. Once doctors perform these procedures, they charge the government for reimbursement. </span><span style="font-family: inherit;font-size: 1.6rem">In these systems, patients don’t worry about the costs of medical treatment. Some may pay a fee for visits, depending on their income, but largely, the costs and payments are handled by the federal and provincial governments. Although it is called single-payer, users can be required to pay a subscription fee on their own or through an employer, and extended</span>  <span style="font-weight: 400">This discrepancy in cost is driven by two factors: how prices are set, and how medical bills are paid. In countries such as Canada with "single-payer" systems, this process works simply. The </span><a href="http://www.businessinsider.com/us-single-payer-debate-comparisons-to-canada-uk-germany-2017-6"><span style="font-weight: 400">government sets the price</span></a><span style="font-weight: 400"> for a medical procedure </span><i><span style="font-weight: 400">(Business Insider)</span></i><span style="font-weight: 400">. Once doctors perform these procedures, they charge the government for reimbursement. </span><span style="font-family: inherit;font-size: 1.6rem">In these systems, patients don’t worry about the costs of medical treatment. Some may pay a fee for visits, depending on their income, but largely, the costs and payments are handled by the federal and provincial governments. Although it is called single-payer, users can be required to pay a subscription fee on their own or through an employer, and extended health coverage is available through privtae insurers.</span>
<span style="font-weight: 400">Meanwhile, the United States healthcare system is a complex patchwork of government and private companies that cover different segments of the population, but not everyone. One thing the U.S. system has in common with the single-payer model is most patients don’t worry about the cost of medical treatment. </span> <span style="font-weight: 400">Meanwhile, the United States healthcare system is a complex patchwork of government and private companies that cover different segments of the population, but not everyone. One thing the U.S. system has in common with the single-payer model is most patients don’t worry about the cost of medical treatment. </span>
<span style="font-weight: 400">There are two large groups of people who are the exception to this rule: the uninsured and underinsured. These groups are keenly aware of the costs of healthcare in the United States. The average cost of a Silver plan, a common option on Affordable Care Act exchanges, is<a href="https://www.forbes.com/sites/danmunro/2013/09/29/average-cost-of-obamacare-silver-plan-328-per-month/#59f2b7884e3d"> $328 a month</a>. This can also carry a $7,000 <a href="https://www.investopedia.com/terms/d/deductible.asp">deductible</a> -- the price an individual must pay before the insurance kicks in <em>(Forbes).</em></span> <span style="font-weight: 400">There are two large groups of people who are the exception to this rule: the uninsured and underinsured. These groups are keenly aware of the costs of healthcare in the United States. The average cost of a Silver plan, a common option on Affordable Care Act exchanges, is<a href="https://www.forbes.com/sites/danmunro/2013/09/29/average-cost-of-obamacare-silver-plan-328-per-month/#59f2b7884e3d"> $328 a month</a>. This can also carry a $7,000 <a href="https://www.investopedia.com/terms/d/deductible.asp">deductible</a> -- the price an individual must pay before the insurance kicks in <em>(Forbes).</em></span>
<h2><b>Who sets prices, why they’re so high</b></h2> <h2><b>Who sets prices, why they’re so high</b></h2>
<span style="font-weight: 400">The price tag for medical treatment depends on the coverage one has. Prices under Medicare, government-sponsored insurance coverage for the elderly, are set by a private organization called the</span><a href="https://www.ama-assn.org/about-us/ruc"><span style="font-weight: 400"> RVS Update Committee</span></a><span style="font-weight: 400">, also known as RUC.</span> <span style="font-weight: 400">Prices under Medicaid, government-sponsored coverage for the poor and Veterans Affairs, are set by the government, similar to single-payer systems. </span> <span style="font-weight: 400">The price tag for medical treatment depends on the coverage one has. Prices under Medicare, government-sponsored insurance coverage for the elderly, are set by a private organization called the</span><a href="https://www.ama-assn.org/about-us/ruc"><span style="font-weight: 400"> RVS Update Committee</span></a><span style="font-weight: 400">, also known as RUC.</span> <span style="font-weight: 400">Prices under Medicaid, government-sponsored coverage for the poor and Veterans Affairs, are set by the government, similar to single-payer systems. </span>
<i><span style="font-weight: 400">Help report on government insurance in the United States by going to EDIT STORY, or start your own by going to ADD STORY.</span></i> <i><span style="font-weight: 400">Help report on government insurance in the United States by going to EDIT STORY, or start your own by going to ADD STORY.</span></i>
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<span style="font-weight: 400">Prices for private insurance are essentially negotiated between insurers and the doctors and hospitals who treat patients. As hospitals in the United States continue to merge they gain the </span><a href="https://insights.som.yale.edu/insights/why-is-healthcare-so-expensive"><span style="font-weight: 400">market power to charge even more</span></a> <i><span style="font-weight: 400">(Yale Insights).</span></i><span style="font-weight: 400"> For example, according to </span><a href="https://amino.com/blog/appendectomy-cost/"><span style="font-weight: 400">healthcare blog Amino</span></a><span style="font-weight: 400">, the cost of an appendectomy can differ from $9,884 to $18,585, depending on insurer, hospital, and geographic location. </span> <span style="font-weight: 400">Prices for private insurance are essentially negotiated between insurers and the doctors and hospitals who treat patients. As hospitals in the United States continue to merge they gain the </span><a href="https://insights.som.yale.edu/insights/why-is-healthcare-so-expensive"><span style="font-weight: 400">market power to charge even more</span></a> <i><span style="font-weight: 400">(Yale Insights).</span></i><span style="font-weight: 400"> For example, according to </span><a href="https://amino.com/blog/appendectomy-cost/"><span style="font-weight: 400">healthcare blog Amino</span></a><span style="font-weight: 400">, the cost of an appendectomy can differ from $9,884 to $18,585, depending on insurer, hospital, and geographic location. </span>
<span style="font-weight: 400">The cost is near zero for patients with top-tier private insurance. They tend to belong to the </span><a href="https://www.census.gov/library/publications/2017/demo/p60-260.html"><span style="font-weight: 400">56 percent of Americans</span></a><span style="font-weight: 400"> who are covered through their job. The insurance company covers the entire tab aside from a $10 to $50 "co-pay" expense.</span> <span style="font-weight: 400">The cost is near zero for patients with top-tier private insurance. They tend to belong to the </span><a href="https://www.census.gov/library/publications/2017/demo/p60-260.html"><span style="font-weight: 400">56 percent of Americans</span></a><span style="font-weight: 400"> who are covered through their job. The insurance company covers the entire tab aside from a $10 to $50 "co-pay" expense.</span>
<span style="font-weight: 400">When hospitals set prices and insurers pay, patients and doctors have no reason to think about cost, let alone value the staggering numbers. </span> <span style="font-weight: 400">When hospitals set prices and insurers pay, patients and doctors have no reason to think about cost, let alone value the staggering numbers. </span>
<span style="font-weight: 400">Unsurprisingly, this system incentivizes providers to overcharge, which leads to increasing premium prices for insurance – and prices keep getting higher. Even </span><a href="https://www.wikitribune.com/story/2018/02/01/health/amazon-berkshire-hathaway-jp-morgan-announce-plan-to-improve-healthcare-coverage/46032/"><span style="font-weight: 400">top 500 companies</span></a><span style="font-weight: 400"> that can afford the best insurance plans in the country are increasingly passing healthcare costs on to their employees. </span> <span style="font-weight: 400">Unsurprisingly, this system incentivizes providers to overcharge, which leads to increasing premium prices for insurance – and prices keep getting higher. Even </span><a href="https://www.wikitribune.com/story/2018/02/01/health/amazon-berkshire-hathaway-jp-morgan-announce-plan-to-improve-healthcare-coverage/46032/"><span style="font-weight: 400">top 500 companies</span></a><span style="font-weight: 400"> that can afford the best insurance plans in the country are increasingly passing healthcare costs on to their employees. </span>
<a href="https://www.wikitribune.com/story/2018/02/01/health/amazon-berkshire-hathaway-jp-morgan-announce-plan-to-improve-healthcare-coverage/46032/"><i><span style="font-weight: 400">Read more, and add more, on WikiTribune’s reporting</span></i></a><i><span style="font-weight: 400"> on employer-based coverage in the United States. </span></i> <a href="https://www.wikitribune.com/story/2018/02/01/health/amazon-berkshire-hathaway-jp-morgan-announce-plan-to-improve-healthcare-coverage/46032/"><i><span style="font-weight: 400">Read more, and add more, on WikiTribune’s reporting</span></i></a><i><span style="font-weight: 400"> on employer-based coverage in the United States. </span></i>
<h2><b>Reducing cost by making people think about it </b></h2> <h2><b>Reducing cost by making people think about it </b></h2>
<span style="font-weight: 400">The Affordable Care Act, also known as Obamacare, accomplished a few key changes, such as <a href="https://www.reuters.com/article/us-usa-healthcare-kentucky/kentucky-governor-announces-medicaid-expansion-under-obamacare-idUSBRE94817R20130509">expanding Medicaid</a> and covering those with <a href="https://www.reuters.com/article/us-usa-healthcare-california/california-reveals-prices-for-health-insurance-under-obamacare-idUSBRE94M19X20130523">pre-existing conditions</a>. But the law has struggled to reduce the cost of insurance, despite forcing every uninsured person to purchase a plan. The cost of a Silver plan (a common option) in <a href="https://nystateofhealth.ny.gov/">New York is $286 a month</a> for someone making $40,000 a year. With a deductible of over $7,000, it’s a steep price to essentially remain unable to afford medical care. </span> <span style="font-weight: 400">The Affordable Care Act, also known as Obamacare, accomplished a few key changes, such as <a href="https://www.reuters.com/article/us-usa-healthcare-kentucky/kentucky-governor-announces-medicaid-expansion-under-obamacare-idUSBRE94817R20130509">expanding Medicaid</a> and covering those with <a href="https://www.reuters.com/article/us-usa-healthcare-california/california-reveals-prices-for-health-insurance-under-obamacare-idUSBRE94M19X20130523">pre-existing conditions</a>. But the law has struggled to reduce the cost of insurance, despite forcing every uninsured person to purchase a plan. The cost of a Silver plan (a common option) in <a href="https://nystateofhealth.ny.gov/">New York is $286 a month</a> for someone making $40,000 a year. With a deductible of over $7,000, it’s a steep price to essentially remain unable to afford medical care. </span>
<span style="font-weight: 400">The political left’s solution is to adopt a system similar to Canada’s, and allow the government to set healthcare costs. Senator Bernie Sanders, a socialist independent, has led the charge in Congress to move the United States toward a single-payer system, which he </span><a href="https://berniesanders.com/issues/medicare-for-all/"><span style="font-weight: 400">refers to as “Medicare for All.”</span></a> <span style="font-weight: 400">The political left’s solution is to adopt a system similar to Canada’s, and allow the government to set healthcare costs. Senator Bernie Sanders, a socialist independent, has led the charge in Congress to move the United States toward a single-payer system, which he </span><a href="https://berniesanders.com/issues/medicare-for-all/"><span style="font-weight: 400">refers to as “Medicare for All.”</span></a>
<span style="font-weight: 400">For Sanders’ vision to be possible, however, a plan will have to follow a far more solvent model than Medicare, which will likely require increased taxes, reduced services, or increased individual contributions from </span><a href="https://www.wsj.com/articles/social-security-medicare-trust-funds-face-insolvency-over-20-years-trustees-report-1466605893"><span style="font-weight: 400">recipients after 2028 </span></a><span style="font-weight: 400">(</span><i><span style="font-weight: 400">Wall Street Journal</span></i><span style="font-weight: 400">) to remain viable. Medicare's financial woes partly stem from the federal government being </span><a href="https://www.reuters.com/article/us-usa-budget-medicare/obama-administration-seeks-to-negotiate-medicare-drug-prices-idUSKBN0L61OW20150202"><span style="font-weight: 400">barred from negotiating competitive prices </span></a><span style="font-weight: 400">for prescription drugs, which is <a href="http://www.cmaj.ca/content/189/23/E794.full">a key component</a> of the single-payer model <em>(Canada Medical Association). </em>By empowering the government to set prices and select which treatment demands priority, single-payer reduces the cost of healthcare.</span> <span style="font-weight: 400">For Sanders’ vision to be possible, however, a plan will have to follow a far more solvent model than Medicare, which will likely require increased taxes, reduced services, or increased individual contributions from </span><a href="https://www.wsj.com/articles/social-security-medicare-trust-funds-face-insolvency-over-20-years-trustees-report-1466605893"><span style="font-weight: 400">recipients after 2028 </span></a><span style="font-weight: 400">(</span><i><span style="font-weight: 400">Wall Street Journal</span></i><span style="font-weight: 400">) to remain viable. Medicare's financial woes partly stem from the federal government being </span><a href="https://www.reuters.com/article/us-usa-budget-medicare/obama-administration-seeks-to-negotiate-medicare-drug-prices-idUSKBN0L61OW20150202"><span style="font-weight: 400">barred from negotiating competitive prices </span></a><span style="font-weight: 400">for prescription drugs, which is <a href="http://www.cmaj.ca/content/189/23/E794.full">a key component</a> of the single-payer model <em>(Canada Medical Association). </em>By empowering the government to set prices and select which treatment demands priority, single-payer reduces the cost of healthcare.</span>
<i><span style="font-weight: 400">Help report on single-payer and other government-centered healthcare systems by going to EDIT STORY or start your own by going to ADD STORY.</span></i> <i><span style="font-weight: 400">Help report on single-payer and other government-centered healthcare systems by going to EDIT STORY or start your own by going to ADD STORY.</span></i>
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<span style="font-weight: 400">Alternatively, political conservatives have their own ideas of how to reduce costs: force patients and doctors to think about costs before they receive care. </span> <span style="font-weight: 400">Alternatively, political conservatives have their own ideas of how to reduce costs: force patients and doctors to think about costs before they receive care. </span>
<span style="font-weight: 400">The Republican Party is far from united on what this conservative plan looks like, but it likely starts with creating a direct relationship between doctors and patients. This means minimizing the role of “third party” groups, such as government and private insurance companies. </span> <span style="font-weight: 400">The Republican Party is far from united on what this conservative plan looks like, but it likely starts with creating a direct relationship between doctors and patients. This means minimizing the role of “third party” groups, such as government and private insurance companies. </span>
<span style="font-weight: 400">The idea is that if everyone pays directly for their own healthcare, hospitals won't be able to systematically overcharge, and prices will drop. Where this model is applied, costs for patients and the healthcare system are dramatically lower. </span> <span style="font-weight: 400">The idea is that if everyone pays directly for their own healthcare, hospitals won't be able to systematically overcharge, and prices will drop. Where this model is applied, costs for patients and the healthcare system are dramatically lower. </span>
<a href="https://en.wikipedia.org/wiki/Direct_primary_care"><span style="font-weight: 400">"Direct primary care,"</span></a><span style="font-weight: 400"> in which patients pay a monthly flat-fee subscription to their doctor, has been able to offer lab tests and prescription drugs at wholesale prices by cutting insurance companies out of the equation. The difference can be of hundred of dollars, according to an article on </span><em><a href="http://www.businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3"><span style="font-weight: 400">Business Insider.</span></a></em> <a href="https://en.wikipedia.org/wiki/Direct_primary_care"><span style="font-weight: 400">"Direct primary care,"</span></a><span style="font-weight: 400"> in which patients pay a monthly flat-fee subscription to their doctor, has been able to offer lab tests and prescription drugs at wholesale prices by cutting insurance companies out of the equation. The difference can be of hundred of dollars, according to an article on </span><em><a href="http://www.businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3"><span style="font-weight: 400">Business Insider.</span></a></em>
<h2><b>Healthcare system not entirely to blame for poor health</b></h2> <h2><b>Healthcare system not entirely to blame for poor health</b></h2>
<span style="font-weight: 400">While liberal and conservative solutions to healthcare costs differ significantly, there is a shared goal toward promoting the long-term health of the patient, known broadly as "health outcomes."</span> <span style="font-weight: 400">While liberal and conservative solutions to healthcare costs differ significantly, there is a shared goal toward promoting the long-term health of the patient, known broadly as "health outcomes."</span>
<span style="font-weight: 400">The U.S. </span><a href="https://www.cdc.gov/pcd/issues/2010/jul/10_0005.htm#Definitions"><i><span style="font-weight: 400">Centers for Disease Control</span></i></a> <span style="font-weight: 400">defines health outcomes as a statistic that takes into account</span><span style="font-weight: 400"> </span><span style="font-weight: 400">“being alive; functioning well mentally, physically, and socially; and having a sense of well-being.” </span> <span style="font-weight: 400">The U.S. </span><a href="https://www.cdc.gov/pcd/issues/2010/jul/10_0005.htm#Definitions"><i><span style="font-weight: 400">Centers for Disease Control</span></i></a> <span style="font-weight: 400">defines health outcomes as a statistic that takes into account</span><span style="font-weight: 400"> </span><span style="font-weight: 400">“being alive; functioning well mentally, physically, and socially; and having a sense of well-being.” </span>
<span style="font-weight: 400">Other organizations have different definitions, but use the same</span><a href="https://www.healthcatalyst.com/the-who-what-and-how-of-health-outcome-measures"><span style="font-weight: 400"> overarching metrics</span></a>,<span style="font-weight: 400"> such as life expectancy, number of healthy years, and mortality of those with chronic conditions and preventable diseases </span><i><span style="font-weight: 400">(Health Catalyst)</span></i><span style="font-weight: 400">. </span> <span style="font-weight: 400">Other organizations have different definitions, but use the same</span><a href="https://www.healthcatalyst.com/the-who-what-and-how-of-health-outcome-measures"><span style="font-weight: 400"> overarching metrics</span></a>,<span style="font-weight: 400"> such as life expectancy, number of healthy years, and mortality of those with chronic conditions and preventable diseases </span><i><span style="font-weight: 400">(Health Catalyst)</span></i><span style="font-weight: 400">. </span>
<i><span style="font-weight: 400">Help report on what health outcomes are by going to EDIT STORY, or start you own by going to ADD STORY.</span></i> <i><span style="font-weight: 400">Help report on what health outcomes are by going to EDIT STORY, or start you own by going to ADD STORY.</span></i>
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<span style="font-weight: 400">No matter how you measure health outcomes, the United States is </span><a href="http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/#"><span style="font-weight: 400">consistently at the bottom</span></a><span style="font-weight: 400"> of the list <i>(Commonwealth Fund).</i> </span><span style="font-weight: 400">But not all of America's health issues can be traced to the country’s healthcare system. </span> <span style="font-weight: 400">No matter how you measure health outcomes, the United States is </span><a href="http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/#"><span style="font-weight: 400">consistently at the bottom</span></a><span style="font-weight: 400"> of the list <i>(Commonwealth Fund).</i> </span><span style="font-weight: 400">But not all of America's health issues can be traced to the country’s healthcare system. </span>
<span style="font-weight: 400">The Robert Woods Johnson Foundation, a healthcare research firm, found that </span><a href="https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf"><span style="font-weight: 400">80 percent of poor health outcomes</span></a><span style="font-weight: 400"> in the United States are the result of lifestyle, diet, and environmental pollutants. The foundation refers to these as "social determinants," many of which are linked to poverty. </span> <span style="font-weight: 400">The Robert Woods Johnson Foundation, a healthcare research firm, found that </span><a href="https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf"><span style="font-weight: 400">80 percent of poor health outcomes</span></a><span style="font-weight: 400"> in the United States are the result of lifestyle, diet, and environmental pollutants. The foundation refers to these as "social determinants," many of which are linked to poverty. </span>
<span style="font-weight: 400">People from a lower socioeconomic background are more </span><a href="https://www.washingtonpost.com/?utm_term=.687fe7c3372b"><span style="font-weight: 400">likely to smoke </span></a><i><span style="font-weight: 400">(Washington Post), </span></i><span style="font-weight: 400">more likely to live in areas with </span><a href="https://www.scientificamerican.com/article/people-poor-neighborhoods-breate-more-hazardous-particles/"><span style="font-weight: 400">polluted air</span></a> <i><span style="font-weight: 400">(Scientific American)</span></i><span style="font-weight: 400"> and </span><a href="https://www.theguardian.com/commentisfree/2015/nov/29/kis-junk-food-dont-blame-parents"><span style="font-weight: 400">consume junk food</span></a><i><span style="font-weight: 400"> (Guardian)</span></i><span style="font-weight: 400">. So while the U.S. healthcare system struggles to contain costs, public health professionals must also grapple with how to address unhealthy factors that occur outside of hospital grounds.</span> <span style="font-weight: 400">People from a lower socioeconomic background are more </span><a href="https://www.washingtonpost.com/?utm_term=.687fe7c3372b"><span style="font-weight: 400">likely to smoke </span></a><i><span style="font-weight: 400">(Washington Post), </span></i><span style="font-weight: 400">more likely to live in areas with </span><a href="https://www.scientificamerican.com/article/people-poor-neighborhoods-breate-more-hazardous-particles/"><span style="font-weight: 400">polluted air</span></a> <i><span style="font-weight: 400">(Scientific American)</span></i><span style="font-weight: 400"> and </span><a href="https://www.theguardian.com/commentisfree/2015/nov/29/kis-junk-food-dont-blame-parents"><span style="font-weight: 400">consume junk food</span></a><i><span style="font-weight: 400"> (Guardian)</span></i><span style="font-weight: 400">. So while the U.S. healthcare system struggles to contain costs, public health professionals must also grapple with how to address unhealthy factors that occur outside of hospital grounds.</span>
<span style="font-weight: 400">Where the healthcare system does contribute to the national health crisis, is that doctors are incentivized to see as many </span><span style="font-weight: 400"><a href="https://www.rand.org/pubs/external_publications/EP67180.html">patients as possible, instead of making patients well </a></span><i><span style="font-weight: 400">(RAND)</span></i><span style="font-weight: 400">. By not prioritizing what happens to a patient years down the road, doctors can over-prescribe and over-treat conditions that not only drive up costs but also may not necessarily make patients healthier. </span> <span style="font-weight: 400">Where the healthcare system does contribute to the national health crisis, is that doctors are incentivized to see as many </span><span style="font-weight: 400"><a href="https://www.rand.org/pubs/external_publications/EP67180.html">patients as possible, instead of making patients well </a></span><i><span style="font-weight: 400">(RAND)</span></i><span style="font-weight: 400">. By not prioritizing what happens to a patient years down the road, doctors can over-prescribe and over-treat conditions that not only drive up costs but also may not necessarily make patients healthier. </span>
<span style="font-weight: 400">Shaping a healthcare system around health outcomes requires moving away from the fee-for-service model that insurance companies support. The </span><a href="https://prescriptions.blogs.nytimes.com/2009/09/23/a-new-way-to-pay-physicians/"><span style="font-weight: 400">Cleveland Clinic and Mayo Clinic</span></a><span style="font-weight: 400">, considered two of the best medical facilities in the country, pay their doctors a flat salary to avoid any incentives to over-treat patients </span><i><span style="font-weight: 400">(New York Times). </span></i> <span style="font-weight: 400">Shaping a healthcare system around health outcomes requires moving away from the fee-for-service model that insurance companies support. The </span><a href="https://prescriptions.blogs.nytimes.com/2009/09/23/a-new-way-to-pay-physicians/"><span style="font-weight: 400">Cleveland Clinic and Mayo Clinic</span></a><span style="font-weight: 400">, considered two of the best medical facilities in the country, pay their doctors a flat salary to avoid any incentives to over-treat patients </span><i><span style="font-weight: 400">(New York Times). </span></i>
<span style="font-weight: 400">Changing the way doctors are reimbursed is just one aspect of what’s known as</span><a href="https://www.bcg.com/publications/2014/health-care-payers-providers-transformation-value-based-hospital.aspx"><span style="font-weight: 400"> “value-based” care, </span></a><span style="font-weight: 400">and it’s not limited to the United States <i>(Boston Consulting Group)</i>. The Martini Klinik, a prostate cancer surgery group in Germany, measures success <a href="https://hbr.org/2015/09/better-value-in-health-care-requires-focusing-on-outcomes?referral=03759&amp;cm_vc=rr_item_page.bottom">based on factors</a> such as rate of cancer recurrence, erectile dysfunction, and incontinence – common issues with prostate cancer patients <em>(Harvard Business Review)</em>. As a result, 93.5 percent of </span><a href="http://www.uke-io.de/medicalservices/medical-treatment/martini-klinik-prostate-cancer.html"><span style="font-weight: 400">Martini patients</span></a><span style="font-weight: 400"> are fully continent after surgery, whereas the national average is 56.7 percent. And 34 percent of Martini patients experience erectile dysfunction, while the national average is 75 percent</span><i><span style="font-weight: 400"> (University of Hamburg). </span></i> <span style="font-weight: 400">Changing the way doctors are reimbursed is just one aspect of what’s known as</span><a href="https://www.bcg.com/publications/2014/health-care-payers-providers-transformation-value-based-hospital.aspx"><span style="font-weight: 400"> “value-based” care, </span></a><span style="font-weight: 400">and it’s not limited to the United States <i>(Boston Consulting Group)</i>. The Martini Klinik, a prostate cancer surgery group in Germany, measures success <a href="https://hbr.org/2015/09/better-value-in-health-care-requires-focusing-on-outcomes?referral=03759&amp;cm_vc=rr_item_page.bottom">based on factors</a> such as rate of cancer recurrence, erectile dysfunction, and incontinence – common issues with prostate cancer patients <em>(Harvard Business Review)</em>. As a result, 93.5 percent of </span><a href="http://www.uke-io.de/medicalservices/medical-treatment/martini-klinik-prostate-cancer.html"><span style="font-weight: 400">Martini patients</span></a><span style="font-weight: 400"> are fully continent after surgery, whereas the national average is 56.7 percent. And 34 percent of Martini patients experience erectile dysfunction, while the national average is 75 percent</span><i><span style="font-weight: 400"> (University of Hamburg). </span></i>
<span style="font-weight: 400">Judging a doctor on health outcomes may seem obvious, but at this point it’s more the exception instead of the rule in the United States. Patients may return to their doctor after an initial treatment, and that doctor will profit from the repeat customer.</span> <span style="font-weight: 400">Judging a doctor on health outcomes may seem obvious, but at this point it’s more the exception instead of the rule in the United States. Patients may return to their doctor after an initial treatment, and that doctor will profit from the repeat customer.</span>
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