Last week I posted article asking a pertinent question “If U.S. Spending is so Outrageous, Are We Getting the BEST?”
The answer is “kind of”.
We do have the best technological and medical advancements in the world, and our acute care and treatments can deliver miracles. We don’t have to wait 4-6 month for a surgery, we mostly get timely care, good care, and we do have great outcomes. However, as wonderful as that is, it does not impact the overall measurements of ‘life expectancy’ as it falls under the category of ‘acute care’ and we do really well here.
It is injuries or conditions lasting more than 6 months that are considered ‘chronic’ and require ongoing management, ongoing medication, follow-up doctors visits, repeated test, etc… and that’s where the U.S. is seriously lacking. So yes, while we are very good at acute care, we lack in chronic care management – and that does impact the overall ‘life expectancy’ and quality of life.
Which brings me to the fact that even after spending over $8,000 per capita in overall healthcare expenditure in 2010 (the highest in the world) , the U.S. has a lower life expectancy compared to other OECD nations. Why is that? Is “healthcare” to blame? Is “public health” to blame? Or is it due to our “population diversity and behaviors“? I have heard many blaming it on the “diversity & behaviors” part, but in that case a question remains – isn’t it the health and life expectancy of the whole population, no matter what diversity groups it includes, that makes for ‘life expectancy’ studies, surveys and measurements?
I agree with you that our diverse population is an integral part of our society, however, it is 21st Century and everybody knows that if you want to live longer and have a good quality of life, when you are not feeling well or have certain episodes – you should go see a doctor. And this is where the crux of “it is population diversity & behaviors fault” argument weakens, as 50 million of low-income working Americans (yes, majority about 80% are working and 82% are legal citizens) DO NOT have options or access to a non-acute or preventive care, so they go without seeing a doctor, without taking medications, and without ongoing management of preventable conditions – NOT because of their population diversity or behaviors – but because under the current system they have no viable option for obtaining health plans!
This clearly and directly impacts the overall life expectancy and thus the overall quality of healthcare we as ‘all Americans’ get.
If 1 in 5 Americans don’t have access to health care – it seriously impacts all of us in terms of loss of economic potential, loss of productivity, and in the end, in an increase in overall health care spending.
I ask again, does $8,000 per capita (twice as much as others developed nations) deliver the best health care to our society? Does it…?
Now, since we established that “population diversity & behaviors” are not to blame for lower U.S. life expectancy, is it a fault of healthcare, or public health? The answer is “yes” as the status of U.S. health care and it’s overall total health care spending and expenditures is a direct result and implication of U.S. health policies implementations. States are responsible for health care but federal government plays its role in Medicare, Medicaid, CHIP & other programs.
Medicaid, for example, by covering health care needs of pregnant women and prenatal care is not only delivering health care, but also implementing a U.S. public health policy. Smoking cessation programs – public health issue, or health care issue? Both, as continued smoking leads to lung cancer, COPD, emphysema etc… and that is very costly in terms of health care spending. Public health programs are offering smoking cessation in order to prevent future health care spending, a clear integration of health care and public health policies.
Without proper public health policies we will not be able to deliver proper health care to our diverse population. Clear and simple.
Yes, while certain “diverse” behaviors cause increase in health care spending (i.e. smoking, bad diet etc..), if we look at it closer – these behaviors span all socio-economic levels, not only diverse population often mentioned. So we are back at the beginning, why the U.S. has lower life expectancy that other OECD nations? The one clear answer is that it is not due to “population diversity and behaviors”.
Are you defining the population of people that “DO NOT have options or access to a non-acute or preventive care” as those who are employed but do not have insurance? How is that number established? Is the number adjusted to account for the clinics that are established to provide primary care on a sliding fee scale or for no charge?
You are making some very important, valid points. One thing I realize since I obtained my degree in public health is that few people who do not have a degree in public health, other than my children, understand what it truly encompasses. The people I work for do not understand what it means. They know what I can accomplish, but they do not understand the extent of my training or what PH is. Heck, I had no idea what it was until I tripped over the director of the program – literally – at med school. And I changed from med to PH knowing that was the path I needed to be on.
I just wanted to follow up on our last years’ conversation here on my blog and invite you to visit and join my new professional FB page titled “Marketa’s World VIVA Politics, Healthcare & Global Affairs”.
I started it one late evening last week and what can I say… It is a learning process as me, as an Administrator, am now the administrator of my own FB page 🙂
The link to my FB page is at the top of my latest Ukraine article, plus it comes right up when typed into FB search.
You will see me in the banner with bunch of kids in a rural village in a school yard at the foot of the Himalayas.
I am looking forward to continuing our discussion and our professional growth.
I hope to see you in my social media world, come and Czech-out my FB page of my updated LinkedIn profile.
After almost 6 months without a computer, I am finally back online – will see how long this lasts…
I will ck out FB and do more reading of your articles once I get caught up. Thanks for thinking of me 🙂