Challenges in Access to Healthcare and Payment Systems

Despite having some of the most advanced clinical protocols in the world, the United States struggles with making basic healthcare services accessible to everyone who needs them, argues Carladenise Edwards, a board member of the Health Care Financial Management Association (HFMA) and the American Board of Internal Medicine (ABIM), and formerly the the Chief Strategy Officer at Henry Ford Health System.

The payment systems are not adequately designed to ensure that institutions get reimbursed fairly, nor do insurance systems provide sufficient coverage for those who fall ill.

Global Comparisons and the Need for Economic Reform

Globally, the United States stands out for its advanced clinical protocols and ability to treat and cure diseases. However, the challenge lies in making these advancements accessible to everyone. The issue is not about reforming healthcare but rather reforming the economics associated with accessing healthcare. The COVID-19 pandemic was expected to be a wake-up call for the urgency of universal healthcare access, but significant changes are still needed.

Telehealth and Digital Solutions

The pandemic accelerated the adoption of telehealth, making it possible for care to be delivered anywhere. This shift also necessitated new ways to pay for and reimburse these services. Telehealth has the potential to address some of the access issues, especially in rural areas where there may not be enough providers.

However, the financial means to access care remain a significant barrier.

Breaking Down Access to Care

Access to care can be broken down into two main areas:

• Availability of providers
• Financial means to access care

Some communities have enough providers, while others do not. Telehealth can help bridge this gap by allowing providers to offer services remotely. However, if individuals cannot afford to go to the doctor, they still cannot access care. This financial barrier often leads to people delaying care until they are gravely ill, increasing the cost of treatment and worsening outcomes.

Financial Challenges and Solutions to Healthcare

Even with health insurance, high deductible plans and cost-sharing can deter people from seeking care. Health systems need to think creatively about how to address these financial challenges. Transparency in pricing is essential, but it is not a magical solution. Health systems should offer multiple payment options and educate patients about these options to ensure they do not delay care due to financial concerns.

Innovative Solutions and Education

Health systems are implementing various innovative solutions to help patients with payment. These include:

• Payment plans
• Charity care
• Financial counseling

Education is also crucial. Many people are unaware of how the healthcare system works and who ultimately pays for care. By educating the public, we can help them make informed decisions about their health and finances.

Redistributing Healthcare Resources for Better Outcomes

The United States spends a lot on healthcare but often does not achieve the desired outcomes. This discrepancy is partly due to where and how the money is spent. A more equitable distribution of resources could improve overall health and well-being. For example, focusing on preventive care and addressing social determinants of health could reduce the need for expensive, catastrophic care.

A New Approach to Spending

Instead of concentrating resources solely on treating the elderly, we should consider the health needs of younger populations who may have more comorbidities. By improving the health of people aged 35 to 55, we could reduce the long-term burden on the healthcare system. This approach requires a shift in how we allocate resources and prioritize spending.

The Role of Health Systems in Improving Access

Health systems play a crucial role in improving access to care. They need to focus on what they do best and strive for excellence in those areas. By specializing and achieving better outcomes at lower costs, they can increase access to care for more people.

Specialization and Efficiency

Health systems should:

• Double down on their strengths
• Use digital and virtual solutions
• Achieve economies of scale

By specializing in specific areas, health systems can provide high-quality care at lower costs. This approach allows them to serve a larger population and improve overall health outcomes.

Collaboration and Competition in Healthcare Systems

Achieving better access to care also requires a shift in mindset. Health systems need to move from a competitive to a collaborative approach. By working together, they can ensure that patients receive the best care possible, regardless of where they are treated.

The Role of Aggregators

Aggregators, such as managed care companies and insurance providers, can help patients navigate the healthcare system. They can identify the best providers for specific conditions and coordinate care to ensure that patients receive comprehensive treatment. This approach can improve outcomes and reduce costs.

Improving Healthcare Towards a Healthier Society

Improving access to care and addressing payment challenges requires a multifaceted approach. Health systems need to focus on their strengths, use digital solutions, and collaborate with other providers. At the same time, we need to rethink how we allocate resources and prioritize spending to achieve better health outcomes for all.

As we move forward, it is essential to keep asking critical questions and seeking innovative solutions. By doing so, we can create a healthcare system that is truly patient-centric and accessible to everyone who needs it.