Action needed to heal US healthcare system – InsuranceNewsNet


American life expectancy has fallen two years in a row. The first year attributed to the COVID-19 pandemic has been consistent with other countries. It wasn’t the second year.

Regardless of how much our nation spends on health services that have achieved 4 trillion dollars 2020 or something $12,500 per person, these funds provide fewer health benefits to Americans.

Doctors are at the center of our healthcare system. They are emotionally and physically overwhelmed, and a growing number are simply burned out. Many felt this way prior to the COVID-19 pandemic; the pandemic worsened their plight. As a result, doctors and health professionals are leaving their profession at an alarming rate, reducing the quality and quantity of available health services.

Many problems contribute to this situation. Here are two that are of particular concern.

#1 is pre-approval for health insurance: Health insurers are increasingly controlling the delivery of patient care, usurping that authority from physicians. Pre-approval forces physicians to expend resources fighting for their patients and ultimately getting paid for the services they deem necessary.

Many of the problems mentioned by doctors can be solved by reforming health insurance. Recent legislation requiring prior authorization for Medicare beneficiaries is a welcome advance. The No Surprise Act is also a step in the right direction. It protects patients and physicians when emergency services need to be provided off-network or when patients are provided with services off-network while being treated in on-network facilities. But it’s just a bandage for a deeply damaged compensation system. How health care is paid for requires a complete overhaul.

The biggest losers of such reforms would be the health insurance companies. They make big profits on the backs of doctors and other healthcare providers. The industry earned more than $31 billion of profits in 2020, an increase of more than 40% compared to 2019.

To defend their position, health insurers make large contributions to elected officials who are empowered to effect significant change in support of doctors and patients. Such a conflict of interest protects the entire health insurance industry from much-needed changes that threaten the status quo.

The second area of ​​concern is direct-to-consumer marketing: the pharmaceutical industry provides the medical devices that doctors rely on. It targets patients with direct-to-consumer marketing that encourages patients to inquire about such products when they visit the doctor. This enables doctors to explain their advantages and disadvantages.

Many of these products are new. There are often cheaper alternatives that offer similar benefits and are covered by health insurance. When patients say “Dr. Using Google” before their visit, physicians not only have to conduct their own investigation, but also spend valuable patient time averting self-diagnosed problems.

An informed patient offers physicians many advantages. However, when such information crosses the line of self-diagnosis and self-treatment, and a lack of confidence is expressed, physicians spend their time defending the results of their own investigations and assessments in adversarial rather than cooperative settings.

The net effect of this dysfunction is contributing to physician burnout that threatens the viability of our nation’s healthcare system. Other healthcare providers experience similar effects. This results in fewer doctors and providers with fewer healthcare services available, all at a higher cost to consumers.

Sensible changes are needed in the way health care is delivered and paid for. What are the options?

Health insurers should adhere to a common set of rules. The concepts of in-network and out-of-network should be abandoned. Every provider in the country should be classified as in-network.

The fee for services should be replaced by a fee for health, increasing the value of the services that provide the greatest benefit to patients and their well-being. This places great emphasis on preventive medicine as well as healthy lifestyle and dietary habits.

Physicians and other providers must steer the nation’s healthcare ship. They must be trusted stewards for prior authorization to be eliminated or used only to protect patient welfare.

If the health insurance companies usurp this authority, everyone but the companies lose. When physicians and other healthcare providers lose control of patient care, the health of our nation’s healthcare system is threatened, and the health of the population follows suit.

Achieving positive outcomes requires meaningful change that puts patient health first.

Spending more does not mean better health, as evidenced by many countries that spend less than The United States, but have a longer life expectancy. It depends on what the money is spent on.

Until such changes are made, physicians and other healthcare providers will retire, making it more difficult for a growing segment of the population to access quality healthcare.

COVID-19 did not cause this situation. It revealed it.

At the root of the problem lies a mismatch between health and healthcare and how it should be paid for. Restoring doctors to their rightful position can start the healing process.


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