Last week, we introduced some of the root causes of runaway healthcare spending and healthcare access issues in this country. This week, we explore the complex and systematic issues that are keeping us from making progress toward affordable, accessible, and cost-effective healthcare:
- Shortage of primary care providers
- Lack of health literacy
- An epidemic of disengaged consumers
Shortage of primary care providers
According to the National Association of Community Health Centers
, 56 million Americans of all income levels, race and ethnicity, and insurance status have inadequate access to a primary care physician due to shortages of these physicians in their communities. That’s before health reform adds another 32 million insured citizens into the current healthcare delivery system. But why the shortages? The cause is twofold.
First, too many primary care physicians are retiring, and not enough medical students are choosing the primary care field to replace them. This would be a problem even in the current system, but as healthcare reform brings in millions of new patients and our aging population increases, the situation will become even more bleak. Under the current system, patients are best served by a traditional primary care physician, but it’s very clear that there won’t be enough to go around.
The second reason is largely economic. Too few medical students are choosing to train in primary care. Starting salary for primary care physicians can run as low as a third of that of their specialist colleagues. As a result, students are increasingly opting for specialization training. But even if every primary care residency program had the funds to offer more positions and could fill them all, it would take decades to make even a dent.
To meet this immediate need, either primary care doctors will need to increase their current patient load between twenty to thirty percent, or millions of people will need to go without a primary care doctor. Neither of these options is acceptable
Lack of health literacy
Health literacy—the ability to find, understand and act on health information, either written or verbal—is essentially the degree to which an individual is able to understand options, weigh risks versus benefits, comprehend the costs of different treatments and preventive measures, calculate health insurance costs, fill out complicated medical forms, and navigate the complex healthcare system. Last week, we discussed the low percentage of adult Americans who can be considered “health literate.”
Although insurers and physicians have curriculum to help improve health literacy, it isn’t widely used in schools, and many of the school programs that do exist are falling victim to budget cuts. The problem with patient education initiatives is that they’re costly and “unscalable” because they are labor intensive and rely on one-on-one nurse educator coaching or in-person classroom instruction. Perhaps more importantly, medical professionals don't have the time to provide this type of training due to high patient loads, nor do they have financial incentives—in general, medical professionals are rewarded for treating illnesses, not for preventing them. As a result, doctors rarely train patients to self-manage health, risks, and conditions.
Before a majority of Americans can be health literate enough to manage their own health, risks, and conditions, we’ll need to bridge a gaping digital, educational, and enablement gap.
An epidemic of disengaged consumers
Inasmuch as we’d all like to think we’re actively engaged in our health on a daily basis, in reality, very few of us are in the habit of proactively making value-based health choices or optimally managing our own health, risks, or the chronic conditions we might have. Even though most of us say our health is a high priority, few of us do much beyond an annual trip to the doctor―that is, until we or someone we care about develops an illness or other serious health issue.
Maybe it’s a case of wishful thinking. Strangely, 90 percent of U.S. adults
report that they are in good health, even though 47 percent of the population has a chronic disease and 66 percent of the adult population is overweight or obese. Perhaps it’s our own blissful self-unawareness that explains why we have an epidemic of disengaged consumers who smoke, eat too much, eat the wrong things, don’t exercise, and have come to expect a pill for everything. Despite the fact that unhealthy behavior is the most common cause of chronic diseases, consumer disengagement is the default state and consumer engagement is the exception. Unfortunately, our current, reactive care delivery system both creates and reinforces this behavior.
But another possible reason why we’ve found ourselves in the midst of an epidemic of consumer disengagement is that the “consumerization” of healthcare has conditioned us to equate health with coverage. As a result, we don’t think of our health as an asset that we own and take responsibility to protect.
To put this in perspective, imagine how carefully we would care for our cars if each of us was issued just one car at age 16 to last our entire lifetime—a car that we could never trade in, repair, or replace. We would take extraordinary care of that car, realizing that it was critical to our lifestyle and livelihood. We’d raid our latte budgets to pay for an oil change every few thousand miles and for preventive maintenance every six months. If we viewed our health as a precious, non-renewable asset, we’d take the necessary steps to protect it, so it, too, would serve us in good repair for a lifetime. Instead, we look to healthcare as a car owner looks to a mechanic—someone who will always be there to fix whatever breaks for a fraction of the true cost, regardless of misuse or poor maintenance.
The challenge, then, is to fundamentally change the way that we, as consumers, think about and manage our health. Only then can we can expect consumers to realistically assess the state of their health, actively engage in their health, make positive lifestyle choices, and manage their health proactively rather than waiting until symptoms appear.
Next week, we’ll discuss ways in which we can overcome some of these barriers to becoming a healthier nation that requires and demands less costly but more readily available care. We’ll explore incentive programs, new engagement models, transformational technologies, and solutions that that exist right now as well as some that are possible for the future. Tell us where you’re seeing progress. Leave a comment below, or chat with us on https://twitter.com/#!/Health_IT
with the hashtag #DigitalDivide.