Thankfully, as the New York Times reported in June of 2013, “The smoking rate among adults in the United States has dropped again.” Quoting 2012 statistics, the article states that 18% of US adults were cigarette smokers versus 18.9% in 2011.

However, though the statistics provided by the Centers for Disease Control and Prevention are based off data from a decade ago, they provide a good glimpse into the burden that smoking places on care providers and how it is a major factor in decreasing positive outcomes in our health care system. One CDC infographic shows that the average annual death rate from smoking was around 443,000, with 29% of those deaths from lung cancer and 28% from ischemic heart disease.

The CDC experienced varying levels of smoking-related morbidities between states, stating “During 2000-2004, substantial variation occurred in the estimated absolute number of deaths caused by cigarette smoking across the 50 states and DC. Such variations have been observed previously and are the result of differences across states in total population size, demographic characteristics of state populations, and in smoking prevalence.”

The American Cancer Society offers some pointed insights, calling tobacco use “the single largest preventable cause of disease and premature death in the US” and, most shockingly, shows vast differences in tobacco-related health care expenditures in the US and elsewhere, with $96 billion spent in the United States between 2000 and 2004 compared to runner-up France’s $16.6 billion.

Based off these numbers, it’s clear that smoking is a major factor in our massive health care expenditures, and there is a significant difference in morbidity rates in states where smoking is more or less common. “Far more American smokers (40%) than European smokers (9%) smoked 20 or more cigarettes per day.” Is it any wonder that positive outcomes are rarer in the United States?

http://well.blogs.nytimes.com/2013/06/25/why-smoking-rates-are-at-new-lows/?_php=true&_type=blogs&_r=0

http://www.cdc.gov/tobacco/data_statistics/tables/health/attrdeaths/index.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5802a2.htm

http://www.realclearscience.com/journal_club/2012/11/10/who_smokes_more_
americans_or_europeans_106403.html

As we’ve been addressing the quality of health care in the United States as compared to other developed nations, particularly in Europe, the question that arises is whether or not the cost we pay for health care in our country is worth it. Solely looking at reports such as those released by The Commonwealth Fund and the World Health Organization make it appear that our health care system is not worth the high cost we pay for it.

However, as Dr. Scott W. Atlas, MD asserts, “Even before medical care quality is compared, one should understand that a population’s lifestyle, behavior, and heterogeneity impact health outcomes and life expectancies, even when medical treatment is sound.”

Interesting. In a country that many from around the world come to for excellent medical treatment, I would assert that our ratings as compared to other countries are low because we, as a nation, are actually hurting ourselves. It doesn’t matter if you have the best surgeon in the world if you keep living a self-destructive lifestyle.

In this next series, we will investigate lifestyles in the United States and the effect they have on our health care system’s efficiency with the dollars we put into it. For a brief glimpse into what we’ll be covering, cigarette smoking accounts for almost one fifth of US deaths and obesity in the United States is higher than in Western Europe, according to Dr. Atlas, and our lifestyles cause and contribute to morbidities such as high blood pressure, cancer, and heart problems. We will be investigating regional, ethnic, cultural, and economic factors that play into our health care rank. I believe this will be a revealing glimpse into our health care system’s interaction with our culture!

http://www.foxnews.com/opinion/2013/01/15/facts-about-americas-health-care-quality-that-world-doesnt-know/

Public domain photograph from defenseimagery.mil.

“Whether measured relative to its population or its economy, the United States spends by far the most in the world on health care”, states Mark Pearson, head of the Division on Health Policy at the Organization for Economic Co-operation and Development mentioned in an interview with PBS NewsHour, summing up the issue of American health care costs in comparison with other the costs of other countries around the world.

According to Organization for Economic Co-operation and Development (OECD) data released in 2012, the U.S. spends $8233 per year per person on health care. That’s a massive difference between the U.S. and runner-up Norway, which measures in at $5388, as shown in NewsHour’s graph. The graph shows that our contender, Germany, spends nearly half per person in health care at $4338.

However, according to Exberliner magazine, Germany’s health care system is in a difficult situation with rising costs as well due to having both a private and a public system, in the editor’s opinion, who states “Inefficiency is as big a problem as injustice. Keeping Germany healthy is chronically expensive: this country has the fourth highest health expenses in the world and the compulsory individual fees, be they state or private, carry on rising faster than inflation.”

On the U.S. front, many explanations are offered. Harvard’s Dr. David Cutler’s recipe for high costs in the United States is administrative costs due to varying insurance systems, high pay for doctors, supplies, and pharmaceuticals, and patients receiving more medical care, as stated in an interview with NewsHour. He explains the additional coverage in the U.S. as compared to Canada: “Sometimes [Canadians] wait longer. What’s much more common is that there’s a lot of gray area where it’s not clear if you need the open heart surgery or not, and in the U.S., people will get it and in Canada, they don’t,” and goes on to explain that life expectancy is comparable between the two countries following a heart attack.

In an article written for Forbes, contributor Todd Hixon cites the issues of high rates of private payers for specialists, high Medicare and Medicaid pay rates, higher per capita income in the U.S., high referral rates for advanced care such as hospitalizations, CAT scans, and MRIs, administrative costs, and costs from the tort system. He concludes, “The data I found says the dominant problem with U.S. health care costs is a labor problem with medical professionals. Wages and work rules (i.e. referral decisions leading to over-utilization, staffing levels in hospitals) have driven costs to a level that is now unbearable.”

One main issue we in the health care field can focus on is the level of necessity for discretionary treatments such as surgeries and CAT scans. As we focus more on personalized care for the individual, I believe we can make better decisions and eliminate some of the excessive costs for care which, in turn, drive up insurance rates. This just gets to the tip of the iceberg on costs and ramifications of different health care systems in the bigger picture beyond the short-term bottom line, but I’d love to hear your thoughts!

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/

http://www.thelocal.de/20100510/27107

http://www.pbs.org/newshour/rundown/why-does-health-care-cost-so-much-in-america-ask-harvards-david-cutler/

http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s-health-care-costs-so-high/

Last week, the United States went foot-to-foot with Germany in a narrow win for the Germans in the World Cup, but how do the two compare in the world of health care? In my last blog, we discovered some key differences between the United States and the rest of the world in quality of care.
We can trace Germany’s current health care system back to the trade guilds developing a health care plan that inspired the government’s system which “combines decentralized power and decision-making with an effective negotiating system that takes place at federal, state, and local levels,” according to the Context Institute, which adds that “there is a sense of solidarity among Germans that everyone should have access to medical services, regardless of employment income, or ability to pay.
Many, such as The Atlantic’s Olga Khazan, view the German system as one we could stand to learn a thing or two from: “Every German resident must belong to a sickness fund,” she states, “and in turn the funds must insure all comers.” According to Khazan, “It’s not as radical as single-payer models like the U.K.’s where the government covers everyone,” but instead there are “about 160… nonprofit insurance collectives in the country.” Khazan adds, “There are no network limitations, so people can see any doctor they want. There are no deductibles, so Germans have no fear of spending hundreds before their insurance ever kicks in,” and states that Germans have the easiest time among developing countries at getting into a same-day or next-day appointment.
However, not having networks is not always a good thing. Khazan mentions that due to a lack of provider networks, “there are few ways to limit repeat procedures,” and are trying to implement parts of the HMO model in the U.S. The American Institute for Contemporary German Studies sums up the comparisons between the two countries’ systems by stating, “The United States faces severe challenges in access to health care, cost effectiveness, equity, and to a lesser extent in coordinating care. Meanwhile, the German system is confronted by problems in coordinating care and controlling costs.”
The cost issue is a major point, one that will determine the sustainability of quality in health care systems around the globe. We will explore that key issue more in depth in future blogs. What are your thoughts so far on the questions of efficiency and overall quality?

Sources:

Comparing Health Care Systems

http://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/
http://www.aicgs.org/issue/issues-in-the-german-and-u-s-health-care-systems/

“Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system,” asserts Maggie Fox of Reuters, citing a 2010 report released by the Commonwealth Fund that ranked the United States last based on measures of quality and equity of care against 6 other developed nations.

This year, stacked up against 10 other developed nations, the U.S. still ranked last in The Commonwealth Fund’s health care report, according to Dan Munro, a Forbes contributor. Munro states that although the U.S. ranked best in some measures of quality, namely “provision and receipt of preventative and patient-centered care,” the United States fare poorly in the areas of access, efficiency, equity, and healthy lives, which Munro defines as “mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60.”

Though we in the health care industry must examine ways to improve quality in light of these metrics and in light of studies such as the 2013 Health and Voluntary Workplace Benefits Survey by the Employee Benefit Research Institute, whose subtitle states “Nearly 90% of Workers Satisfied With Their Own Health Plan, But 55% Give Low Ratings to Health Care System,” others, such as Dr. Scott W. Atlas, M.D. assert that our health care quality is excellent and that the Affordable Care Act could pose a threat to our quality, implying that it is an inhibitor to innovation. Dr. Atlas counters The Commonwealth Fund’s claims that our nation’s outcomes are worse than our European counterparts due to poor quality of care, attributing poor treatment outcomes to significantly higher rates of obesity and historical cigarette use in the United States.

Lifestyle appears to be the hidden variable in these international studies. Dr. Atlas goes on to provide evidence that treatment for heart disease, cancer, and chronic conditions such as hypertension and diabetes is superior in the United States when compared to Western European nations.

Whom do you believe? Or is there truth to both sides? Either way, we as health care professionals have a duty to continually raise the bar higher, excel in innovation, and provide personalized, compassionate care to our patients.

Sources: http://www.reuters.com/article/2010/06/23/us-usa-healthcare-last-idUSTRE65M0SU20100623 http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/ http://www.ebri.org/pdf/notespdf/EBRI_Notes_09_Sept-13_WBS-RepRts2.pdf http://www.foxnews.com/opinion/2013/01/15/facts-about-americas-health-care-quality-that-world-doesnt-know/

Supply and demand. It’s a key question in access to care. Are there enough supplies, enough medical personnel, and enough facilities to meet demand – or is there an excess of supply and a lack of demand? And how does Obamacare affect the supply/demand balance?

In an alarming article released last October (“Doctor Shortage, Increased Demand Could Crash Health Care System”), CNN’s Jen Christensen expressed concern due to an increase of previously uninsured patients wanting to utilize newly-available benefits from the Affordable Care Act. “Combine that with a worsening shortage of doctors, and next year you may have to wait a little longer to get a doctor’s appointment,” warns Christensen, “And the crowded emergency room may become even more so.”

Christensen states at the time of her writing that there is already a shortage of doctors, needing about 20,000 more to meet demand, that about half of our nation’s doctors are approaching retirement age, and that there is a shortage of nurses as well.

We see a similar supply-and-demand issue in the recent VA scandal, with 120,000 veterans experiencing long waits for health care, including those whose scheduling information VA medical centers have falsified or mishandled, according to Dennis Wagner of azcentral.com. A recent round of audits have revealed that a number of VA facilities used unofficial scheduling lists in order to make wait times appear shorter than they really were. RT.com states that according to some, over 20 veterans have died recently because of long wait times for treatment.

These issues raise important questions for our society. How can we encourage more students to become doctors and nurses with an aging population that will need them more? Can we effectively make health care more financially available while ensuring there is enough supply? Finally, how can the management of health care contribute to shorter waits to ensure that care is available to those who need it, especially those who have served our country? We must, more than ever, encourage and foster innovation and creative solutions for these major changes, legislated and natural, that are facing the American health care system today.

Sources:

http://www.cnn.com/2013/10/02/health/obamacare-doctor-shortage/

http://www.azcentral.com/story/news/arizona/investigations/2014/06/09/va-scandal-audit-veterans-delayed-care/10234881/

http://rt.com/usa/161136-veteran-affairs-admits-deaths-delays/

Photo Credit: Ildar Sagdejev CC (Modified)

For the next few weeks, we will be exploring the concept of access to care, so I thought it appropriate to address what it encompasses in a general sense before diving into our current healthcare situation in the United States.

Access to care, simply put, addresses the questions of ability to receive care and the quality of care that is received. Here are some factors to consider:

Supply of Services – Are there enough doctors, nurses, care providers, medicines, medical supplies, and facilities to serve the population in question? Does the supply adequately meet the specific needs of the population, or is there an excess of unneeded personnel or supplies and a shortage of those that are desperately needed?

Acceptability of Services – Is the health care that is accessible appropriate for the need in question? Is the care that is provided of high or low quality? How are medical personnel trained and how do they perform their services?

Barriers to Access – What are the cultural, social, financial, and organizational hurdles to those who are in need of care? Are there stigmas and prejudices that need to be addressed? Are there inefficient processes within health care-related organizations such as government health programs, insurance companies, and care providers? What keeps some from not being able to afford much-needed care?

Physical Accessibility – Where is the nearest doctor or hospital? Is there ease of accessibility within facilities to those who have a physical handicap?

Of course, the issue of access to care is a deeply personal and human one. When push comes to shove, every decision that is legislated becomes something that effects many individuals, and each story is different. The goal, ultimately, is to create a positive outcome for as many people as possible.

Before we dive in to these specific areas, what are your thoughts on the effects of the Affordable Care Act on all of these accessibility issues?

Source: http://www.ncbi.nlm.nih.gov/pubmed/12171751

“We can lower health care costs and fix real problems without a government-run system that puts unelected Washington bureaucrats between you and your doctor,” said Louisiana Republican Rep. Steve Scalise, the committee chairman.
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The following are examples but are certainly not limited to triggers that will provide warning indicators that they or their family members may consider the placement of a family member in a LTC facility from an in home care setting.

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Over the years, the abilities of families to become caregivers were made easier because of several reasons. Forty years ago families were bigger. Two or three generations lived in the same house. Life expectancy was shorter, and seriously ill family members were not expected to live longer. Today, elderly live independently from their children, families are scattered across the country, and most adults cannot stay home to provide care.

So now what? Who can provide the care necessary for our family member?