I’m studying for my Health & Medical class and need an explanation.

Doctors for America is a national movement (organization) of physicians and medical students working together to improve the health of the nation and to ensure that everyone has access to affordable, high-quality health care. Review the following statement released by Doctors for America (n.d.), regarding the U.S. Health care Delivery System:

“Our health system is broken and much of the problem lies with the fragmentation of our delivery system which drives low-quality and inefficient care in a country filled with highly skilled health care professionals. The US lacks a single national entity or set of policies guiding the health care system; doctors and hospitals practicing in the same community and caring for the same patients are not “connected” to each other. Our current healthcare payment model—a mix of private insurers and public programs, each with its own set of rules and payment algorithms —further fragments the health care delivery system, contributing to waste and high administrative costs.”

Discuss your opinion of the above statement. Do you agree? If so, why? Do you disagree? If so, why? Do you agree partially? If so, why? Be sure to clearly state your position/opinion and support your analysis with scholarly sources.

reply 1

I agree with the statement that our healthcare system is broken but the reasons are vast and each one difficult to correct. Yes, our delivery system is fragmented and not very well connected and yes our payment model is chock full of perverse incentives such as pay-per-service rather than pay-per-positive outcome, but there are many other reasons such as high drug costs. Did you know that Americans pay 50-80% more than what Canadians, Australians, and Europeans pay? One of the reasons for this is that other countries allow for price negotiations within their healthcare system (either government or regulatory body). Since America has chosen to leave its healthcare system up to the free market, negotiations from a regulatory body is impossible (Rook, 2017).

Another reason is the lack of cost transparency. Most hospital systems cannot answer what the cost of a medical procedure is before the procedure is accomplished. This ridiculous, backward method of doing business comes from procedure codes which is a process so complex that there are actual college majors dedicated to it (Rook, 2017).

Yet another problem with the current healthcare system is inflated billing. This is where the healthcare system charges an inflated amount to an insurance company to ensure that they get paid the maximum that the insurance company is willing to pay. This does not have anything to do with what it actually cost the healthcare provider and everything to do with maximizing profit per service (Rook, 2017).

There are other reasons as well but suffice it to say that our current healthcare system will not be improved until there is an elimination of the perverse incentives (pay-per-service) that is currently in place at every stop along the healthcare train. Additionally, consumers need to be empowered with the ability to shop for value and increased care options instead of being forced into government-mandated insurance whose costs are and have proven to be impossible to control.

reply 2

In this week’s discussion, I agree that our health care system is broken. There are various mix of private insurers and public programs with different rules and regulations in providing health care services to its clients. “The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating healthcare coverage for almost everyone” (Department for Professional Employees, 2016). In this matter, medical costs, rehospitalizations, medical errors, and other medical issues increases. According to Centers for Medicare & Medicaid Services (2013), the rising costs of health care must be improved the way that health care is delivered by coordinating care and improving the safety through the Affordable Care Act. An integrated approach from interdisciplinary disciplines decreases hospital spending, improves health outcomes, protects patient privacy and confidentiality, and continuous quality improvements. There has to be a solution to this dilemma including reforms and investment to improve healthcare coverage and allow the population to shop medical treatments according to their needs. Overall, an enhanced and unified health care systems strengthens then health quality of care and process improvements towards health promotion and disease prevention.