Why The U.S. Health Care System Sucks

You're not alone in having fears regarding the accessibility of the current health care system. So many Americans, whether belonging to the employed, self-employed, or unemployed sector, have been made victims by the vicious cycle of high costs and restricted medical services by the very people who proclaim to provide "quality health care."

What happened here?

It all boils down to one word: Competition.

Competition by nature isn't bad. When it comes to health care, when all the major players involved: health care payers, providers, employers and subscribers, share the same goal of providing and receiving quality, efficient health care, competition will ensure just that.

But when these major players don't share the same goal, and instead look out for their own interests, then the outcome for you, and everyone else, is grim.

There are a number of flaws within the US health care system, most of which are a result of bad practices by the 3 key players: health care payers (health plans), providers (hospitals & physicians), and employers (the major purchaser of health care).

Some of the major flaws are the following:

1. Main goal of these key players is not to provide affordable health care, but to reduce cost.
2. Focus is on "Who pays?" which results to passing of costs from one player to another.
3. Competition between providers remains largely local.
4. Patients' treatments are determined by which network they belong to.
5. Health care policies discourage/restrict their subscribers from seeking out treatments or physicians outside their network.
6. Hospitals through mergers end up focusing on quantity instead of quality when it comes to the services they offer.
7. Important information, like a provider's track record of experience and treatment outcomes, isn't available to the public.
8. Deep discounts are given to large groups or employers who enroll large patient populations.

These major flaws are the culprit behind the jungle that has become of the U.S. health care system. Sadly, these flaws are still present today.

Due to the flaws within the health care system, it has brought about negative effects, most of which are shouldered by people like you, the subscriber, and ironically, even the providers themselves.

One example is the practice of cost shifting. The cost of the health plan is passed from health care payer to patient, health plan to hospital, hospital - physician, and so on. In short, the gains of one player are made at the expense of another player. This in turn makes the cost of health care to rise even higher.

Another is the health care policies that restrict the choices of both the providers and their subscribers. Providers are only allowed to make referrals within their network, and some policies even give penalties to physicians who make outside referrals. This has resulted to pressure to undertreat patients, which in turn demoralized physicians.

As a result, the options for treatments are limited for the subscribers, and rob them of the opportunity to seek out more experienced physicians or more innovative treatments from better-equipped hospitals that can be found outside of their network.

Unfortunately, these bad practices have been within the health care system for too long, that it'll take a tremendous amount of work, and will need the participation of ALL players, if change is to be made.

It will be difficult, yes, but possible.

There is still hope for the U.S. health care system to be what it was originally meant to be: affordable, efficient, quality health care for every American citizen.

And it starts with all the players accepting and sharing one goal: to improve VALUE. It pertains to the quality of health outcome per dollar spent, which will be measured at the disease and treatment level, not at cost level.

4 Things That Can Make A Big Improvement in US Healthcare System

Here are the steps that should be taken to effect change and improve the health care system.

Competition at the right level - Health plans, networks, and providers shouldn't compete as to who has the most subscribers, or who should shoulder the cost. Instead, they should compete based on these guidelines: prevent errors, boost efficiency, and develop expertise.

Compete nationally - Competition between providers should not remain local, but should spread nationally. This way, providers will be pressured to constantly improve their services, and those who are treating less common conditions can improve their efficiency and expertise since they will be serving a wider area.

No restrictions - Providers should be free to make referrals based on what they think is best for their patient, and not on who are included within their network. Subscribers in turn are also free to seek out outside referrals, at no or minimal additional cost.

Fair pricing and simplified billing - Providers should charge the same price to any patient for a given medical condition, regardless of the patient's health care provider. Also, providers will simplify the billing process by issuing only one bill for each service bundle, and not multiple bills for each discrete service.

As with any problem involving multiple players, there is someone who needs to make the first move. For changes to be made in the health care system, who do you think it should be?

The health care payers?

Or the providers?

Surprisingly, the key player who has the power to make that crucial first step is the employer.

Why?

Because employers are the major purchaser of health care. The shift in goal, from reducing cost to seeking out who gives the best value, should start with them. They have the power to push health care payers and providers to give efficient, quality health care to their subscribers.

It can be said that employers are the "prime movers" of the health care industry. After all, big and small businesses comprise the biggest category of health care buyers. And yes, there's a LOT at stake for employers if the health care industry situation doesn't improve.

These days, the cost of health care for employers increases faster than the U.S. Inflation rate, often reaching into double-digits. This is naturally a cause to worry for most CEO's, who try to find ways to keep costs down. And that's part of the problem.

To keep costs down, employers buy health care from the cheapest providers, and not necessarily the ones that provide the best quality of health care. This actually perpetuates the problem - while health care costs go down, other costs - such as professional medical fees - keep going up.

The good news is that there are many things business owners can do to effect a positive change in the health care industry. One of the most important ways is to get health plans that do not limit their employees only to certain treatments and providers.

When a health care provider doesn't allow employees to seek health care outside its network, it's a sign that they don't really care about the quality of care their clients get. And that's never a good thing.

Also, when shopping around, employers should prefer health care providers who readily provide their track record, the health care standards they adhere to, and information about cases they've handled. If they withhold such information, it could mean they're not really customer-friendly.

What's more, employers should readily provide information about common diseases, treatments, and alternative health solutions. This is not only for the good of the company, but also for the good of the medical industry itself, because new information about health and wellness is not disseminated well enough by the health care industry. (Sometimes it's even suppressed!)

There are many other ways employers can help fix the health care conundrum in the U.S., such as by:

· Insisting that their employees only be treated by skilled, experienced medical professionals;

· Require that health care providers post a single fixed fee for each service;

· Require that health care providers send only one bill per hospitalization; and

· Make sure the health care providers do not bill their employees directly.

By making these changes in their approach to find good health care for their employees, business owners can start developing a preference for health care providers who focus on quality, not low costs. This will then provide incentives for health care professionals to get better at their crafts, and even to focus on certain diseases, to further drive down costs and drive up quality.

It will take a long time to break the cycle, but it has to be done – otherwise health care costs will keep going up, and quality will remain mediocre in the United States.