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The United States has the highest health care expenditures in the world, in terms of absolute dollars, dollars per person, and as a percentage of GDP 1.  The United States is also one of the few industrialized countries to have very limited government health coverage for working adults.  While insurance premiums are currently price transparent, many aspects of health care are not cost transparent at all.  Historically, it was not standard practice to publish prices of procedures or tests to patients prior to performing them.  Patients would not learn about the true cost until they received their bill later.  This was complicated by the various prices for the same test or procedure depending on the patient’s health care coverage, or lack thereof.  This made it very difficult even for informed patients to make financially informed decisions about where to obtain certain procedures or even if they were truly necessary.  One example from 2012 demonstrated, for mammograms in the Boston area, an average cost of $310 per mammogram but a range from $176-$529 2.  This information could have helped save a patient potentially hundreds of dollars had they had access to it.  Unfortunately, at the time of writing this entry, these prices are often only obtainable with persistence, if at all.

The good news is that, as of January 1st, 2021, The Executive Order EO on Improving Price and Quality Transparency in American Healthcare to Put Patients First goes into effect 3.   This will mandate all hospitals and providers to provide the standard prices for procedures and services.  This includes both the gross price of all services and procedures, but also the amount charged to individual insurers 3.  The most immediate benefit will be that it will allow patients to make financially informed decisions about non-urgent services.  One big caveat is that while this executive order will provide information about cost, it will not include any information regarding the quality or value that any particular institution may provide.  Some information regarding quality of an individual organization can be found at Medicare.gov 4.  While competitive pricing is critical to help stabilize or even decrease the cost of health care, one should be careful to measure it carefully with the quality of the health care obtained.

For more information regarding health care transparency and medical reform, click here.

Bibliography:

1. 1.”National Health Expenditures 2018 Highlights”. National Health Expenditure Data : Historical. Centers for Medicare & Medicaid Services. December 2019. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.
2. “Provider Price Variation: For Mammography Services in the Commercial Market”. Center for Health Information and Analysis. October 2014. https://www.chiamass.gov/assets/docs/r/pubs/14/rp-mammography-chartbook.pdf
3. Postma, Terri MD and Grimsley, Heather. “Hospital Price Transparency Final Rule”. Medical Learning Network. Center for Medicare & Medicaid Services.  December 2019.  https://www.cms.gov/files/document/2019-12-03-hospital-presentation.pdf
4. “Hospital Compare”. HealthCare.gov. https://www.medicare.gov/hospitalcompare/search.html

The right to health was initially recognized by the World Health Organization (WHO) in 1946. According to WHO, the enjoyment of health is a fundamental right of every human being regardless of race, political belief, or religion. The debate over whether health care is a right or privilege has been raging for more than a century. Here is a look at the definition of health care and health care providers and whether health care is a right or  privilege.

Health Care and Health Care Providers

Healthcare is the provision of medical care to individuals and communities. Healthcare careers are not limited to doctors and nurses but also include chiropractors, administrators, therapists, and technology professionals.

According to federal regulations, a health care provider is a doctor of medicine, dentist, podiatrist, clinical psychologist, nurse, or any medical personnel, authorized to practice by the State and working according to the standards laid out by State law. A healthcare provider is; therefore, anyone who is legally permitted to administer healthcare to patients.

Is Health Care A Right or Privilege?

The right to health care is internationally recognized but this does not mean this right is enforced worldwide. In the U.S., health care was included in the Second Bill of Rights that was drafted by Franklin Delano Roosevelt. His wife took his work to the UN which led to the clarification of health care as a human right in the Universal Declaration of Human Rights (UDHR).

After the adoption of the UDHR, all industrialized countries implemented universal health care programs to make sure their citizens enjoyed the right to health. However, in 2015, the U.S. report to the UN does not acknowledge health care as a human right. The U.S. does not have a health care system but only a health insurance system in the form of Medicare and Affordable Care Act. It is; therefore, reasonable to claim that in the U.S. and many developed countries health care is more of a privilege than a right.

The Houston Health Initiative is a group of health conscious patients and physicians who have come together to maintain and improve the health of each member of their group. The goal of HHI is to change the way Americans pay and receive medical care. If you want to learn about the state of health care in the country, or to make a change to the health care system in the U.S., Houston Healthcare Initiative has got your back.

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The number of uninsured people in the United States has slowly been rising for the past few years. A KFF analysis of the data gathered by the U.S. Census Bureau shows that 10.9% or 28.9 million people under the age of 65 were uninsured in 2019. This problem is only made worse by the fact that many people who are uninsured avoid medical attention until they are experiencing a medical emergency. Preventable or manageable conditions are made worse and much more expensive when this is done. The U.S. Census Bureau tabulated the reasons why those people were uninsured, and the overwhelming majority, 73.7%, said that coverage was simply not affordable for them.

If you find yourself in the same or a similar situation where medical insurance is unaffordable, you need to know that there are options for you to receive proper medical care. One such option is a community health center. These health centers can also be referred to as Federally Qualified Health Centers (FQHCs) or community clinics, but they all operate similarly. They are non-profit clinics that provide quality health care to people at a very low cost regardless of income or insurance status. Today there are over 1,400 community health centers across the U.S., making them not only affordable alternatives to for-profit hospitals but also very accessible no matter where you live.

Despite the fact that you may be asked to pay only a small fee, you’ll always receive comprehensive, quality care at one of these clinics. That’s because their quality of care is heavily tracked to ensure that they are always providing good care to their patients. These health centers can provide primary preventative care, ongoing care, coordination with specialty care, and much more. For those with severe financial struggles, some of these clinics have on-site social workers who can coordinate benefits through connections they have in your community.

Almost every state has a network of community health centers that can provide low cost or free health care to people regardless of their insurance status or level of income. If you’d like more information about this or like topics, visit Houston Healthcare Initiative (HHI). We are an organization of like-minded physicians and other medical professionals who are looking to help change the nature of our public health in the U.S.

A popular opinion in the United States is that the current health care system is broken. Health care in the United States costs more than that of comparable countries but does not provide greater or even equal quality of care when compared to those same countries. Many people and organizations are actively attempting to fix this problem, but without the people’s approval, they cannot effect real change. Unfortunately, most people don’t understand the problem or where it stems from. This article should give you a little more understanding of the problem.

The healthcare industry used to be just like any other industry in a free market. People would judge care by its quality while contrasting that to its price. Now, insurance allows people to ignore the price of care by introducing a copay that is much smaller than the actual cost of their care.

Since the price is not of much concern, hospitals no longer need to show their prices in order to get patients. As hospitals improve the quality of their care by upgrading technology and techniques, prices go up. At the same time, patients now are more likely to get unnecessary treatment because they are only expected to pay a small copay.

These two factors contribute to the price of insurance increasing. The increase in insurance price increases both your copay and the amount your employer is expected to contribute. Because employers do not gain from contributing more, cuts have to be made somewhere to maintain profitability, this is usually your pay. Unfortunately, now you cannot afford to opt-out of your employer’s insurance because the cost of healthcare has risen too high.

In addition to these problems raising the cost of healthcare, uninsured people also raise the cost of healthcare for everyone. This is because people who do not have insurance are likely to not seek medical attention until a problem goes from bad to worse to emergency. In these events, prices go up for everyone because the hospital has to make up for their loss.

To further add to the problem, affordable health care legislation can backfire by raising the price of healthcare depending on the provisions within. There are many more factors that play into the cyclical nature of this problem, such as pre-existing conditions, managed care plans, insurer networks, and businesses simply going bankrupt. For more information on this topic and many more related to the health care industry, contact Houston Healthcare Initiative (HHI) today.

Many complain about our current healthcare system but little has been accomplished to make it patient centered. I believe that a patient centered healthcare system can be accomplished by using a patient owned healthcare cooperative model that is free from the constraints of the CPT codes used for billing and by providing financial incentives to patients to be compliant and lead a healthy lifestyle. Physicians rather than insurance companies and administrators should be responsible for care and would be compensated based on results. Profits from the cooperative would belong to the patients rather than an insurance company. One vision of  healthcare in the future is described below. Changes could begin incrementally, starting out with a conventional healthcare cooperative. Utilization of these changes should be voluntary on the part of the patient.

Screening for disease.

An annual physical examination including physical and mental fitness, weight, vital signs and age appropriate screening tests would be performed. If disease is found, appropriate treatment is begun.

Acute Illness

Rather than making an appointment to see a doctor or go to the ER/ Urgent Care, the patient can tap an app on the smartphone and talk to a physician in a few minutes. The patient would grant access to the physician to his/her medical record. The patient would report the symptoms as well as vitals signs – Blood pressure, pulse and temperature. (every patient would have the means of measuring these.) The physician could take the history and do a telemedicine exam; order lab tests and imaging; summon an ambulance; supervise the EMT’s; order transport to the hospital as necessary and treat the patient during transport.

If patients are well enough, they can go to the imaging center that also has a drawing station for blood work by car or  “cabulance”. Alternatively, blood work, EKG, plain x ray and ultrasound can be performed at home. This would all be performed the same day or night.

Most patients will not be very sick and simply need a diagnosis, reassurance, oral medication or first aid instruction. If necessary, diagnosis can be aided by AI.

Simple procedures e.g. suture of laceration can be provided by skilled technicians that come to the home and supervised by the physician

Sicker patients can be cared for at home with an aide to help with routine care and food preparation. Nurses can administer intravenous treatment; oxygen therapy and medication.

They can draw blood and help physicians perform telemedicine exams. The original doctor can call in specialists that can consult via telemedicine or if necessary in person. If necessary, treatment can be guided by AI.

Patients with unstable vital signs will still need transport to hospital for treatment of major trauma, heart attacks, GI bleeding, pulmonary emboli, acute stroke. Hospitals will be better equipped to handle these patients in the ER by avoiding the clutter of patients that do not have a life threatening emergency.

Chronic illness  e.g. diabetes, obesity, hypertension, seizure disorder, mental illness

A treatment team supervised by a specialist would care for the patient. Members of the team would consist of the patient, dieticians, physical therapists, psychologists, social workers, clergy, personal trainers, medical assistants, nurses or other skilled people necessary to care for the illness. A physician designed algorithm would help guide treatment. Problems with treatment compliance could be addressed by team members as well as the physician. Visits to the physician office would be rare. Results of treatment would be measured in terms of end organ damage e.g. to the heart, kidney, brain,musculoskeletal system.

Diagnostic Problem Cases.

When a patient has a symptom that is not resolving with initial treatment or where the diagnosis

Is not clear e.g. cause of dizziness, cause of anemia, breast lump found on mammogram, a diagnosis should be arrived at in a few days and appropriate treatment begun. This can best be accomplished if the patient goes to a facility where tests and specialty consultation can be performed in a few days. This facility would not provide nursing care or overnight stay. But would have a quiet space for patients to study and read; other space for a gym, TV, video games or other entertainment. There would be Exam rooms for specialists. Laboratory and imaging would be available on site with a 24 hour turnaround. Specialists would see the patient the same day or next day. This is similar to a hospital without beds, nursing care and bedside food service. Once the diagnosis is made, a treatment should be established and begun in 24-48 hours. The center would be judged on accuracy of diagnosis as well as efficiency.

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A Brief Look at the Numbers: Average cost of hospitalization in 2018 was about $10K; the average charge with private insurance was about $20K (The average charge to the uninsured ranges from $40K to $60K) Average number of hospitalizations per year was about 9/100 for ages below 64.

Total annual payments for hospitalization/100 people= 9x20K= $180K

Annual outpatient charges are estimated at $500

Total annual outpatient charges/100 people= $500×100=  $50K

Annual drug costs across the population estimated at $1200. We can reasonably assume

that drug costs are higher for the over 65 population. We would estimate this to be $500

In the under 65 population.

Total annual drug charges/100 people =$500×100= $50K

Total costs of reinsurance with $50K deductible+purchase of PPO discounts=$20K

If we add these costs together, we find the total charges/100 people= $300000

Notice this is the total cost. Insurance typically pays about ⅔ of the cost; ⅓ of the costs are paid out of pocket in the form of copays and deductibles.

The very cheapest Blue Cross policy for a 31 yo male in zip code 77096 was $257/month or

$3084/yr. The cost for 100 people would be $308K annually but would have a $7400 deductible.( At age 50, the cost was $4000 annually.) The high deductible means that outpatient care is not paid for and that the insurance only pays for the reinsurance and hospitalization costs of $200K.

The gross profit for the insurance company is at least $100K (income per 100 patients of at least $300K less claims of $200K)

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