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What is Healthcare, Health Care, Health-care?
Healthcare. Health care. Or is it health-care? The term “health care” is amongst the top 20% of all web searches on Merriam-Webster 1. What does it really mean? what does it constitute? and why is healthcare so important to the well-being of a society?
Let’s first start with the basics. Webster’s defines healthcare as the field that is concerned with the “maintenance or restoration of the health of the body or mind.” The reason that most look up the term “health care” is not because they lack knowledge on what the meaning of the word is, as most have a general idea. Rather, it is due to some level of confusion due to the spelling 2. This is something that most people can relate to when it comes to figuring out how to spell those seemingly simple, yet tricky words found in the English language.
The word Health care is a noun. Health care is intended to be used when the subject is a person. Also, it can be used and when the term is used as an action. For example, “Steve needs to develop a proper health care plan for himself.”
Health-care the term is used as an adjectival form. For example, “the health-care resources provided by the hospital are adequate but costly.”
The term “Healthcare” is used as a noun or adjective. It is defined to be the industry, field, or system which works to provide medical care for the people. Emphasis on the system component.
So why is it so important to be able to distinguish between these various terms? Well, it’s certainly to avoid any confusion in discussing the main topic of this article. However, it is also to distinguish between the terms for our own understanding.
Brief Overview of Health Care in the U.S.
The U.S has a predominantly private healthcare system with a mix of public healthcare funded by both the federal and state governments 3. Individuals are able to receive access to healthcare through private insurance, which is offered primarily by employers for the individual and can be extended for the family. The benefits, extent of coverage, and monthly insurance costs vary depending on how much both the employer and individual contributions towards a particular health policy or plan.
As for the public programs, Medicare and Medicaid are national healthcare programs. Medicare provides funding for coverage for those above the age of 65, whereas Medicaid serves to provide coverage for low-income individuals. There is no universal healthcare program in the U.S.; however, the Affordable Care Act (ACA), passed in 2010, served to increase the accessibility of healthcare resources to those who may not have been covered under existing public and private systems. As of 2018, 8.5% of the population still does not have access to health insurance (27.5 million people), which is lower than the 16% figure measured in 2010.
So What’s the Problem
Although healthcare costs have been rising for a while, there has been a rapid increase in costs in just the last few decades 4. In 1970, the health expenditure of the country constituted about 7% of the GDP, while in 2018, the figure is closer to 18%. There was a roughly $1 trillion dollar increase in spending towards healthcare when comparing total spending in 2009 to 2019 when adjusted for inflation. Based on current projections, spending will continue to increase from the $3.8 trillion spent in 2019 to an estimated 6.2 trillion in 2028. This corresponds to around a jump from around $11,000 spent per person to $18,000 spent per person 5.
Now, there is nothing wrong with spending more on healthcare services, especially if it is for the benefit of the larger society. However, it is imperative to examine whether such spending is being used in the most efficient manner to achieve the best results for the population, as an existing system can always continue to be improved.
Health Outcomes
A relatively recent analysis demonstrated that the U.S. was spending nearly twice as much per capita as comparably developed countries. At the same time achieving the worst health outcomes in many important areas of measure. In particular, the life expectancy was ranked to be the lowest, chronic disease burden and obesity rates were measured to be the highest, and the number of visits to the doctor per capita per year were amongst the lowest.
However, there were many areas in which the U.S also excelled, as the country was measured to do great in prevention measures (such as flu vaccinations and breast cancer screenings) and has the highest average five-year breast cancer survival rate. Since the populations that compose the U.S. are diverse, a more in-depth analysis may be required to find what is the root cause of the health outcomes seen. As for the figure on the lowest number of visits to the physician, a potential explanation for the relatively lower number of annual visits to the physician could be due to the general physician shortage.
Although the explanations for such outcomes could be complex, it is projected that costs will continue to rise. To better utilize such resources for the best outcomes for the population, it is important to figure out how the system can be made more efficient.
COVID-19
A more recent, indirect effect is due to the COVID-19 pandemic. It is estimated that over 50% of the public delayed getting medical help in fear of the pandemic 5. The delay in treatment is a massive issue as the problems of the patient may increase over time. This can result in more care being required later on. This in turn could lead to higher health care costs for patients as a whole.
Increase in Prices in Healthcare
There is no single reason as to why costs and expenditures in healthcare are increasing. However, there are some which are becoming more apparent and need to be examined more carefully.
One prominent factor is increasing pharmaceutical drug prices 5. The price of pharmaceutical drug have been on the rise due to the lack of governmental policy or restriction that limits how much companies can charge in the U.S.. Other industrialized nations have limits on the maximum prices of drugs, keeping prices in check. Some studies have found that U.S. prescription drugs cost over 256% more than other industrialized countries. These excessive costs deter patients from out-of-pocket spending and force them to resort to insurance. This results in individuals to have to pay more for health insurance coverage or pay out of pocket.
Services as Populations Age
As a community grows to prosper, the general standard of living increases. Increases in quality of life also causes an increase in the number of people that live to an older age. Thus as cost for providing such services would therefore also increase as the population which requires such services is another reason why costs are increasing. The costs associated with chronic illnesses, ambulatory services, and insurance premiums have also increased due to a greater demand for the use of such services.
Due to the scale of such services, it can be difficult to track and manage expenditures for healthcare services. This can result in inefficiencies in utilization of such resources. Legislation such as the No Surprise Act hopes to combat such issues ( effective on January 1st, 2022). This bill hopes to safeguard individuals against surprise medical bills and calls for an increase in transparency regarding the deductibles and cost of services received. The Act also mandates for dispute resolution and a price comparison tool to be maintained for the care of the patient. The price comparison tool will allow patients to choose what healthcare plan will suit their needs at a price that fits their budget.
Revamping and improving the current healthcare system to reduce costs while maintaining the quality and standard of care received by patients will help the both the individual and larger community by opening up the accessibility of healthcare resources and services to a larger population. Cost reduction through efficient spending is a route that can and must be pursued for the benefit of all.
Table Showing U.S. Average Costs vs Other Industrialized Nations 8.
| Countries | Administrative Costs per Capita (Dollars) | Long-term care per Capita (Dollars) |
| Average of Countries | $173 | $928 |
| Australia | $159 | $101 |
| Belgium | $179 | $1,154 |
| Canada | $167 | $961 |
| France | $289 | $802 |
| Germany | $293 | $1,157 |
| Italy | $64 | $388 |
| Japan | $76 | $807 |
| Netherlands | $213 | $1,578 |
| Sweden | $95 | $1,443 |
| Switzerland | $284 | $1,456 |
| United Kingdom | $80 | $769 |
| United States | $937 | $516 |
Solutions
This problem is something that can’t be fixed overnight and by one soul. It will take changes in multiple areas and a big push from lawmakers to make rules moderating drug prices, figuring out health plans that can cover those in need without waste with greater accessibility to healthcare for all Americans.
A solution for private citizens is to seek care regularly and immediately upon the onset of illness or malaise. Reluctance in accessing proper care for one’s condition may lead to worsening effects over time which may necessitate more attention needed to the problem. For example, if a patient is having problems with their knee and they just ignore it for months or years it could get so damaged to the point where not only surgery is needed, but a replacement knee may be required. While if the patient seeked care immediately after pain started, he or she may have been able to avoid the surgery and undergone physical therapy.
Some current solutions to the healthcare crisis are being worked on currently by the Biden administration. President Biden has recently signed the American Rescue Plan (ARP) in March of 2021. This expands the ACA in terms that more families are allowed to qualify for coverage, and provides subsidies for insurance premiums to families laid off until Sep. 2021.
Technology
Advancements in technology have allowed for humanity to progress in unprecedented ways and transform the world. Breakthroughs in research have allowed for improvements to be made regarding the delivery of care. Technological advancements, medical research, and clinical knowledge and experience can be used to further develop and streamline healthcare resources. In doing so,it is hoped that a greater amount of tools, techniques, tests, and methodologies can be developed through collaboration amongst healthcare practitioners such as physicians, scientists, and researchers to drive further innovation for the benefit of all.
A possible way to improve the efficiency of the healthcare system is to incorporate the use of information technology 6. Information technology is where all the patient’s data is stored and is updated in real-time. This allows other healthcare providers to see what’s happening and can work together on a patient. Also, it allows every treatment, operation, and even patient satisfaction to be measured in real-time.
Patients are able to choose what type of care they want and who they want their provider to be. This is only achievable through information technology since patients are able to see their records and able to choose tele-health (virtual healthcare check-ups instead of in-person) if they wish. These options allow the patient to have lower costs since they get to choose providers that fit their needs. On top of this, patients have more access to resources which they believe will provide them with better care since they know at all times what their medical records are. This is unlike the current system where patients have no access to their medical records and what’s on them.
Why it Matters
Everyone needs access to healthcare for a better quality of life. If an issue ever arises regarding one’s health, or if a problem needs to be diagnosed and treated before it has a chance to become serious, then one would need to have access to medical resources.
As the world has progressed, life expectancy has increased globally due to medical advancements, improving the quality of life. If a society is not able to obtain access to essential medical resources due to increasing costs, then it may decrease the overall well-being and health of the community. Also, if individuals aren’t able to get their medical concerns addressed due to barriers in accessibility, then it can deteriorate the overall well-being of that society.
As physicians, it will be our duty to provide care to all who need it. And, we cannot do that if the system is not working in conjunction with us to help patients. This pertains to the healthcare ethic of justice where all patients deserve fair and equal treatment. And with the current problems in the healthcare system, not everyone is able to. This is a significant challenge which needs to be addressed.
The problem of ballooning costs in healthcare is something that will continue to get worse until it is resolved 7. This is why it is important for the current generation of future physicians on their “doctor journey” to be prepared by becoming more informed and and open to discussing new ideas and solutions to address such challenges.
Too Long; Didn’t read
Healthcare is defined to be the system or service which provides medical care to the people. In recent years, expenditures in healthcare have risen dramatically. Spending in healthcare has constituted 18% of the GDP in 2019 as compared to 7% in the 1970s.
The U.S spends more than twice as much per capita than comparable developed nations, although the measured health outcomes in key areas are amongst the worse. To address such increases in expenditure increases in efficiencies and transparency have been called for through legislation. Technological advancements and medical research can and should be used to reduce cost expenditures. This will hopefully increase the accessibility of essential resources. A technological advancement that can be used is information technology where all data of the patient is gathered in real-time.
Furthermore, current lawmakers are proposing and passing regulations that will help the healthcare crisis we are dealing with, but more needs to be done to alleviate the issue. As future doctors, it is important for us to understand the challenges we face, and to be able to better serve the community and allow more equal, accessible care to be received by patients.
by Jashandeep Bajaj and Kartik Goswami