Beyond Local Borders — Elements of Global Public Health

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Mainstream media has cast a provincial focus on healthcare, exhaustively reporting on the inadequacies of the U.S. system. This has caused the blurring-out of the status of healthcare in the rest of the world; this is especially true for residents in developed countries. It is unmistakable that U.S. healthcare is afflicted with severe systemic issues, being the only one of all developed countries worldwide without universal healthcare. However, on the Global Access to Healthcare Index, the U.S. ranks 10th, indicating that there are a multitude of other countries that receive extremely limited access to healthcare (or even none at all). Limited access to healthcare in developing countries has devastating effects on global health outcomes.

I recently attended a series of lectures by prominent field researchers at the University of North Carolina Gillings School of Global Public Health. They delineated the extent of global access issues, and some of the root causes of negative health outcomes. Their stories were startling and eye-opening to say the least. There are a number of reasons for access and outcome challenges, and below I briefly present just a few of many; the following observations are informed by their shared insights and experiences.

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Disregarding Neutrality of Health Workers

Decades ago, health humanitarian workers and healthcare centers were detached from conflict. Workers were generally left alone, and not intentionally targeted. However, this has not been the case over the last many years. No longer regarded as neutral, aid workers are targeted no less than the perceived enemy. One lecturer shared their experience working as a clinician Iraq, reporting the killing of colleagues in the field and the destruction of humanitarian medical centers along with their staff. Their team, affiliated with the Red Cross, did not display the organization’s emblem to reduce negative attention that the symbol may draw from certain groups. What was previously inherent yet calculated risk for healthcare workers has transformed into serious danger and vulnerability. As a result, humanitarian healthcare has significantly decreased in some of the hardest-hit of regions, including Iraq, Afghanistan, and Chechnya. Conflict resolution has been difficult in many regions, especially in the Middle East. Widespread war and indiscriminate assault has reduced healthcare personnel on the ground, severely limiting access for civilians.

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Limited Trained Personnel

There are also a number of developing countries that are not affected by strong conflict, but still face limited access to care and poor health outcomes. In these areas, healthcare workers are more concentrated, but there is often still a shortage of trained specialty physicians. Another lecturer shared their work in Africa with trachoma, an infection that is the leading cause of blindness worldwide; though correctable by surgery, ophthalmologists are far and few in between, causing this treatable disease to cause permanent blindness. Their team actively works on training lower-skilled workers for conducting trachoma surgery, and improving surgical outcomes especially for newly-trained workers. Though this example outlines issues for a specific ocular disease, specialists in diverse disciplines are rare in many areas of Africa and other regions around the world. Those physicians that are present frequently face large numbers of patients to treat with limited human and physical resources.

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Some say that the U.S. healthcare system is the worst in the world. Even as a passionate advocate for equitable access to care, I would disagree. While it is indisputable that significant issues such as prohibitive costs and bureaucratic problems are prevalent within the U.S. system, billions across the world have worse health outcomes than those of patients in the United States. Conflict-stricken environments without healthcare aid workers and regions with limited access to general/specialty care presents an enormous challenge that we cannot afford to disregard.

Conflict resolution is desperately needed to allow for humanitarian aid workers to safely administer healthcare in environments that are currently inhospitable for workers and civilians alike. Without the protection of healthcare workers, we cannot expect notable positive global public health change. Lack of professionally-trained medical workers in certain underserved and developing areas strongly indicates the need for increased health humanitarian assistance, as well as training programs like that for trachoma surgery, to treat endemic diseases that developed nations are fortunate to avoid. To see improvement worldwide, we must balance our perspective by bringing into focus global public health issues that exist beyond the borders of our local communities.

Saving the Titanic of Healthcare — Why Price Disclosures May Not Be Enough

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“Trauma response, stat!”

$5000, stat.

U.S. Healthcare today is an ill-fated ship, headed for collision with the icebergs of zero price transparency and prohibitive pricing, resulting in potentially dire consequences for patients. Unless you’ve seen hospital bills, chances are, you don’t know the cost of procedures or think about them very much. Price-shopping in the service industry is very common; however, for many years, this has not been the case for healthcare. Pricing is nebulous, often intentionally so, leaving many patients in a plight where choosing life over death can equal bankruptcy.

However, new regulations from the Centers for Medicare and Medicaid Services (CMS) in effect as of Jan. 1, 2019 have mandated that hospitals publish price lists on their websites. For instance, we now know that thirty-minutes in the operating room can cost around $6k-10k, and that an hour of observation will cost around $1,500 at the University of Cincinnati Medical Center. At TriHealth Hospital also in Cincinnati, the same duration in the operating room is over $1,000 less, and comparable observation is priced at around only $500.

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These new regulations are certainly representative of positive progress towards a more transparent healthcare system. However, there are several flaws, in many capacities, that indicate price schedules disclosures are not enough.

Education/Comprehensibility

Since healthcare pricing has been forever-secretive, patients are not aware that price schedules exist online. In addition, they may not know where to find them. Lists may be buried multiple webpages deep, many times deliberately. In other cases, there are multiple links to price lists, which cause confusion in selecting the appropriate schedule. This poses a significant challenge for less-savvy users. Some pricing lists, like those for Cincinnati hospitals, are relatively easily accessible, but can have other issues. All are formatted differently, with abbreviations incomprehensible to the average person. Lists are often not completely exhaustive. There is no simple way to navigate or search data sheets with tens of thousands of rows. These impediments can result in the patients obtaining incorrect information, or even giving up on their search.

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Insurance

The price listed online is almost certainly not exactly what you will pay. The majority of Americans have some form of health insurance which will cover some portion of necessary medical procedures. Insurances are derived from many sources, including job-based private plans, state health plans, and Medicare. Your plan will have specifics about what it covers, how much it covers, and what portion comes from your pocket. There are a plethora of plans out there, each unique, and the listed prices from hospitals for procedures do not account for insurance plans. This results in accurate prices being difficult to obtain and remaining mysterious as ever.

Psychology — Sticker Shock

Though you will almost certainly pay less than what is listed, seeing high prices can be discouraging, to say the least. Patients may put off medically necessary procedures or even forego them altogether, due to seeing prohibitive costs upfront. While price-shopping is financially prudent, the perplexing nature of deciphering information from all parties involved takes time. Researching the details and talking with the hospital and insurance company to determine specific details is a laborious process which can be off-putting and delay patient-driven efforts towards preventative care. Simply disclosing prices without a ballpark estimate of actual payment can be detrimental to patient health due to unnecessary sticker shock from unadjusted fee schedules.

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The Fine Print

Fees listed on price disclosures almost always have additional costs that are not listed. The charges for time in the operating room, as discussed earlier for examples in Cincinnati, do not include the cost of medications and supplies. Physician fees, which are variable and not concretely defined or listed, are added on top of everything else. This still excludes the costs of complications that may occur, often requiring more of the hospital’s time and resources, costing the patient and their family even more. Therefore, even with price lists and meticulous research and planning, the true costs of hospital procedures may be unfathomable and volatile, as they have been forever.

Though the new rules from CMS are indicative of a strong step towards healthcare cost transparency, this is just the beginning of a series of steps needed to achieve a healthcare system in which patients are prioritized. Specific changes are necessary for greater impact from the new regulations. Details in the recently released price lists need to be more specific, explaining each abbreviation in clear terms for the patient to understand. A searchable and interactive system, rather than a lengthy database or spreadsheet, expressed in nonexpert terms, will further eliminate the need for a Rosetta Stone in understanding a simple price search. Details regarding physician and medication fees should be included in these lists to at least allow rough estimation of the actual cost. Currently, displaying pricing without factoring in the appropriate insurance coverage may result in people avoiding certain preventative screenings or other procedures due to modified psychology caused by sticker shock. The insurance issue is more complicated due to excessive lobbying and a history of complexities; greater regulation from legislators and CMS is necessary to make plan-specific pricing for all hospitals available to patients in an accessible and comprehensible manner. Stronger legislation over healthcare pricing transparency has the power to support the well-being of patients by setting many of these changes in motion.

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The 2019 regulations represent a strong shift in the right direction. However, simply disclosing prices is insufficient, and the icebergs of inadequate transparency and prohibitive pricing remain imminent. Until we address certain issues to further build upon the new regulations, public health and patients nationwide continue to bear the burden.

The Quagmire of U.S. Healthcare: Will We Ever Get it Right?

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Earlier this year, I visited a community health center in rural North Carolina. On the curved, narrow countryside road, I passed a nondescript building three times prior to realizing that it was the clinic. It was a rather large facility, with medical, dental, and pharmacy services being offered at subsidized costs to uninsured and underinsured patients. Though it appeared promising, the clinic was undersupplied and understaffed, with just a few nurses and one physician. There was a social worker coordinated follow-ups to facilitate continuity of care; she said that it wasn’t uncommon to see individuals with chronic issues once and never again. Closed on weekends, urgent care services were nowhere nearby. In spite of these limitations, this is one of the best rural low-cost community clinic facilities I have seen.

At the other end of the spectrum, some facilities are operated purely by volunteer doctors and nurses. Surrounded by large populations of uninsured patients and being the only healthcare facility in many miles, community clinics may be forced to restrict their care to a few patients only. To make best use of the use of limited physical and human resources, certain community health centers, like the Arlington Free Clinic in Virginia, may run lotteries to determine who will be provided care, and who will not.

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Imagine you, or worse yet — a child, being turned away from a specialty care community clinic due to being overwhelmed at capacity, and then being told to enter the lottery again next month. By American society’s expectations, especially in more urban areas, this would be unacceptable. Though rural and community care facilities operate to deliver financially affordable care to individuals without insurance, they leave much to be desired. However, this is a reality that exists in the U.S. healthcare system in more than one place.

Healthcare accessibility, strongly correlated with insurance coverage, poses perhaps the greatest threat to national public health. As the only developed country in the world without universal healthcare, a resolution for the U.S. is of high priority. Former President Barack Obama was a proponent of equitable healthcare, describing it as a right and not a privilege, instituting the Affordable Care Act and the individual mandate. By 2016, about 27 million Americans were without health insurance, a drop of 17 million from the figure in 2013.

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However, this progress appears unsustained. In his first year in office, President Trump signed the Tax Cuts and Jobs Act on December 22, 2017. This effectively removed the tax on those who opt-out of the healthcare mandate. It has been predicted that, as a result of disincentivizing obtaining coverage, an additional 13 million Americans will be added to the current figure of 27 million by 2027. This is only marginally different than the statistic in 2013.

Privatization also plays a role in hindering a system of universal care. Insurance companies comprise one of the largest lobbying groups, spending hundreds of millions annually. Profit is at their core, and without adequate regulation, private health insurance corporations will act in the interest of financial growth over that of the patients who entrust them with their lives. With multiple parties, private and public, political agendas, and inadequate oversight, it is without surprise that the U.S. system is deeply entrenched in a messy quagmire.

While these issues receive exhaustive coverage from media sources, they are not the only causes of U.S. healthcare’s inefficiency and nebulous complexity.

As a society of instant gratification, we place a large burden on our health system infrastructure when we demand care in a similar way. Canada’s system is often referenced as superior in current discourse, noting its merits of universality and affordability. However, what some fail to recognize is the price that Canadians pay for socialized medicine. Funded by higher levels of taxation and longer patient waiting times for less-urgent procedures, Canada’s health systems have the human and capital resources along with public cooperation to enable universal care.

With two-hour package delivery and the desire for greater tax cuts, American society has become accustomed to the “right here, right now” mentality, and with less available tax dollars, universal healthcare is unlikely and simply illogical.

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Thomas Jefferson wrote of “Life, Liberty, and the Pursuit of Happiness” as the unalienable rights endowed to all. Preserving the right of life most completely, however, is a challenge we have yet to solve. Systemic problems, including discrepancies in quality of care, accessibility to appropriate providers, privatization of insurance, and the public’s demands prevent the development of an adequate solution. We’ve not made much progress in the last decade. The right to healthcare is a unifying force, something that we all share; curing the U.S. healthcare system and coming closer to universality will require unwavering commitment, definite sacrifices, and the prioritization of public health from each player: the individual, legislators, and private enterprise.

How Two Miles and Ten Minutes Can Save You Up To $100 in Healthcare Costs

Although the Affordable Care Act has improved accessibility to healthcare, many of those who are uninsured cite the high costs of insurance as the reason they lack coverage. Not everyone receives coverage through a job, and those living in states without Medicaid, assistance for coverage is nonexistent. In some cases, costs to buy healthcare insurance have dropped. In exchange, however, those with such coverage are faced with sky-high deductibles. The CDC reports that nearly 30 millions Americans are still without healthcare insurance, and the Kaiser Family Foundation reports that studies indicate that 20% of adults without coverage forgo or delay their preventative testing due to prohibitive costs.

One way to avoid excess costs in healthcare, particularly preventative lab testing, is to compare pricing at various facilities. As simple as it may sound, this is an arduous and migraine-inducing task. Lucky for those who must pay out of pocket due to being underinsured or uninsured, the rise of online lab companies who contract with local facilities and the lab corporation giants provide the convenience of price comparisons with ease.

Great. But how can you save up to $100 in under 10 minutes? Send a free inquiry through Health Smart Technologies’ short web form, receive a comprehensive cost comparison, and locate the nearest applicable testing site, and go! Health Smart Technologies does all the work for you: crunching numbers and refreshing data by scouring the web to give you a detailed comparison with the best price highlighted. 

Two Miles, Ten Minutes

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Disclaimer: Prices are property of the providers, and are subject to change without notice. Health Smart Technologies does not endorse these prices, and is not affiliated with any of the corporations listed.