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We spend the most money, but do we see the best results?

The news is enough to give you heartburn. Americans spend more on healthcare than any other country. But the U.S. lags behind when it comes to results.

America’s healthcare system is critically ill, says Dr. Helen R. Turner, associate vice chancellor for academic affairs, senior associate dean in the School of Medicine and professor of medicine at the University of Mississippi Medical Center. “Most health policy experts agree on this. Our country spends more than $6,000 per capita each year on medical care, yet our citizens are less healthy than in other countries that spend much less. An especially vulnerable group of patients are those with no health insurance.”

The ranks of the uninsured continue to increase at alarming rates. It is currently estimated that 45 million people in the U.S. are uninsured, and 20 million of those are working adults. It is estimated that between one in five and one in 10 working adults in uninsured.

The situation is going downhill because the increased cost of health insurance is resulting in many employers dropping health insurance as a benefit.

“Employer sponsored health insurance is rapidly disappearing,” Turner said.

At a cost

The lack of access to healthcare does have a cost. Between a fourth and half of all uninsured adults in the U.S. reported being unable to see a doctor when needed in the past year because of the cost.

“Uninsured patients are less likely to have screening tests to detect diabetes, hypertension, heart disease, cancer and other diseases at an early stage,” Turner said. “They are more likely to delay seeking medical care until their illness is far advanced, often seeking care in a hospital emergency room or requiring hospitalization for a neglected illness.

“Even when physicians provide free care, the uninsured patient is often unable to have prescriptions filled or pay for diagnostic tests. They will not seek follow-up care because of cost concerns. People without insurance often have reduced productivity at work and face higher medical costs that threaten their families’ financial stability.

High numbers of uninsured patients lead to reduced revenues for medical providers and place a huge financial burden on safety-net hospitals and state and local governments. When providers such as physicians and hospitals find it challenging to offer some services, everyone’s access to healthcare is reduced.”

In response to the growing need for healthcare for the uninsured, physicians are providing more and more free care.

According to a recent survey conducted by the American Medical Association (AMA), more than a third of physicians provide five or more hours of charity care in a typical week and 16% provide 10 or more hours per week. About 87% of physicians provide some level of charity care, but continuing to provide that care may pose significant financial difficulties in an era of shrinking levels of reimbursement. In 2004, 32% of physicians incurred more than $50,000 of debt for patients who did not pay for medical care and 21% incurred more than $75,000 of debt.

Comprehensive approach

Turner said the healthcare system in the U.S. is outdated, and the solution to such a widespread, complex problem must be comprehensive.

“The American Medical Association believes that a healthcare system based on a mix of private and public sector financing will best benefit the uninsured while improving quality, restraining costs and expanding patient choice and individual purchasing power,” Turner said. “The AMA’s proposal calls for a comprehensive, three-pronged program that includes tax credits for the purchase of healthcare coverage, individually selected and owned health insurance and the expansion and formation of new insurance markets.

These reforms will foster a wider range of affordable health plans that reflect personal healthcare preferences and needs.”

Turner is seeing little political will to make the changes that are necessary. She said there is little evidence that Congress or federal agencies are able to lead the way.

“How much worse will our obsolete healthcare system have to get before we act?” she asks.

Patients’ personal responsibility

Improving the outcome of healthcare spending in the U.S. is not just dependent on the healthcare system, but on personal responsibility for eating right to maintain a desirable body weight and exercise, says Dr. Eric Lindstrom, an ophthalmologist from Laurel who is president of Mississippi State Medical Association.

“A lot of the problem has to do with the unhealthy lifestyle that our people live,” Lindstrom said. “It is a major scourge on our society. It can be a real, real problem not only in the U.S. but certainly in the State of Mississippi.

Obesity-related illnesses cause an incredible amount of problems. It increases the risk of developing diabetes, hypertension and heart disease. Probably after smoking, excess weight is the second leading cause of preventable death. We just weight too much for the height we are. We eat too much. That is an individual responsibility, something as Americans we don’t like to deal with that much.”

Smoking is another concern, big time. It is estimated that the U.S. loses $75 to $80 billion in lost productivity because of people who are unable to work because of smoking related illnesses.

“Violence, substance abuse and suicide also cost from $85 to $300 billion per year,” Lindstrom said. “We don’t know exactly how much, but it is a huge amount as well. Alcohol and drug abuse, sexually transmitted disease and teen pregnancy all add to costs for our healthcare.”

Making healthier choices

Part of the fix, in his opinion, should be focusing more on preventative healthcare, trying to convince people to live healthy lifestyles rather than trying to fix the health problems that result from bad choices.

Another important area is “evidence-based medicine.” Lindstrom said that is a hot topic now, an important evolving area concerned with relying on good evidence that a procedure provides the best long term outcome. The U.S. has prided itself on having the best medical system in the world. But it has become apparent that it is too expensive to do everything that people want done.

Television advertising has had a big impact. Patients often come to doctors wanting a procedure or drug they have seen advertised on television. A breakthrough has been announced, and everyone wants the newest and best thing.

“Physicians get sucked into it,” Lindstrom said. “Doctors like to be supportive, and want their patients to have the best. But at some point we can’t afford absolutely the best for everyone. We have to look at what works best and do the things that work. Maybe we can get better success for less money.”

Research shows that providing more healthcare services and spending more money on healthcare does not necessarily result in better outcomes, says Dr. Joan L. Exline, FACHE, an associate professor of health policy and administration and assistant to the president at the University of Southern Mississippi.

“In fact, a 2003 study conducted by the Dartmouth research team found that patients in areas where a lot of money was spent on healthcare received 60% more care, but they did not live longer or experience a slower decline in function,” Exline said. “In other words, spending more on healthcare does not guarantee longer or healthier lives.”

Exline agrees there are major concerns about lifestyle choices, especially obesity. At the same time, we don’t know as much as we would like to know about why people continue to make poor lifestyle decisions when they know such behaviors increase risk for poor health outcomes.

“Why do people continue to smoke given what we know about smoking and cancer, heart disease, etc?” Exline asks.

To improve healthcare, many healthcare economists feel that everyone should have a basic level of healthcare insurance.

“Secondly, with a baseline level of insurance comes the need for incentives to promote efficient care, so it is important to realign provider payment policies to achieve efficiency,” Exline said. “Third, we should focus on evidenced-based medicine so we know the value of investing in healthcare services and treatment. Often we don’t have a clear understanding of the costs and benefits of any given diagnostic and treatment protocol.

“Fourth, the buzzword today is ‘consumerism,’ which means involving consumers in decision-making, which means it is important to give consumers information to guide their healthcare decisions. Finally, we need to better coordinate care and services so we use our resources wisely.”
Sometimes a large amount of a person’s lifetime spending for healthcare comes in the final weeks or months. Recently an elderly man in Meridian whose health was failing after catching the flu spent five days in intensive care before his death. The bill for those five days of care, which didn’t include any surgery, was $100,000.

The Mississippi Hospital Association is looking for ways to improve quality and outcomes for money spent on healthcare.

“Many state hospitals participate in quality programs through Information and Quality Healthcare, our state’s Medicare quality improvement organization,” said Shawn Zehnder Lea, vice president for strategic communications for MHA. “Hospitals are also trying to do a better job on educating patients on how they can help ensure the quality of their care. Last year, we launched the Mississippi Patient Safety Coalition to educate both patients and hospital employees on the latest news and research in patient safety.” (For more, visit the Web site www.mspatientsafety.com.)

Lea also points out that although the U.S. has the highest cost of healthcare with poorer outcomes than some other countries, America is a world leader when it comes to medical innovation. She said in the past decade, 12 Nobel Prizes in medicine have gone to American-born scientists working in the U.S., and three have gone to foreign-born scientists working in the U.S. Just seven have gone to researchers outside the country.

Contact MBJ contributing writer Becky Gillette at bgillette@bellsouth.net.

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