Different countries do it different ways, but it’s essentially a combination of taxation and price control.
If our health system is so great, why are our outcomes so poor? You’d think by outspending everyone else, we’d have better outcomes, but that isn’t the case. Despite the issues with single payer systems I don’t see many (any) countries clamoring to emulate our system. I just don’t see how the current situation is sustainable, but we seem to lack the will to really address it.
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Our family has had high expenditures in health care. A member with a debilitating disease that is only controlled with an expensive biologic.
A family member going through cancer treatment caused by a genetic mutation. A young, extremely healthy vegetarian who was an exercise instructor. Who is currently going to exercise classes while undergoing radiation.
A family member who had a heart transplant, caused by a genetic mutation. Was under 50, was purposefully walking until right before they found him a heart. Which is a heartbreaking experience to go through. Because right until they find the heart, you are on pins and needles that they won’t die before a heart is found.
This family members child is currently going through the same heartbreak, will need a new heart before 2 years are up. Under 30, they did nothing to deserve this.
Be really happy this isn’t your family and your experience. We are so incredibly grateful for modern medicine. I love my family so much. But I won’t be sorry that we drew the short straw. And need more than average health care insurance.
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The problem is twofold.
- every transplant recipient prays for 20 years.
2)there is absolutely no way to predict which transplant recipient will get 20 years and which won’t. Every transplant recipient is young enough and healthy enough to get another 20 years. Because you don’t get one if you aren’t.
It’s an absolutely horrible experience to have a family member go through this. It’s because they are young, relatively healthy before the disease. And is required to make the commitment to do everything they can to keep that organ.
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I am sincerely happy for your family member. But anecdotes do not make data, and I am sure we all have examples of wasteful and futile medical intervention. More importantly, the fact that the current system worked for you doesnt begin to address the tens of millions for whom it doesnt work-shall we begin with the 30 million uninsured or the medical bill bankrupted or those who cant afford their prescription?
Our outcomes are bad because there is no emphasis on preventive care.
People do not take care of themselves by improving their diet, exercising more, cutting back on their alcohol consumption, stopping their smoking. They do not routinely visit their primary care physician to detect and monitor chronic condition such as diabetes, obesity, hypertension, and high cholesterol. They are not compliant taking medications, they routinely refuse their recommended vaccinations, and they do not schedule widely accepted cancer screening guidelines. Modern medicine cannot reverse a lifetime of unhealthy living.
However, if you want to live in a nation that can treat your heart attack in 90 minutes (door to balloon time), your stroke in 60 minutes (door to needle time), or see a trauma surgeon (receive your definitive care within the “golden hour”),
and have access (assuming you can pay for it) to any specialist (in any specialty) any time you want, this is the right place.
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I’m curious about the multiple posters who have commented on no emphasis on preventive care. My H’s employer, who we get our health insurance through, gives us all kinds of discounts for preventive care. My D’s company’s plan is the same. Basically if we do our annual physicals, go to the dentist, exercise (and record it), and keep our weight and lab work within normal limits, the discounts nearly pay for our part of the coverage.
My inlaws Medicare supplement also requires them to go to regular preventive appointments to keep their coverage.
Is this unusual?
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Our private insurance has no benefit for preventive care.
Medicare plans often have these requirements (someone posted about it above), because the plans want to get a high quality rating on their Stars Ratings so they can get bonuses, etc. Consumers can also look at the Stars ratings to help assess different plans, so that drives patient volume to the plans as well.
I agree with BUMD that the US population is not healthy…high rates of obesity, high rates of overweight, high rates of diseases related to overweight/obesity, poor compliance with meds, skipping preventive visits and the like.
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We also have incentives but I don’t think many people take advantage of them maybe? Also, the incentives are not why we do all the things we do to stay healthy. I have never understood why friends/family members ( all with good insurance) put off doing things like mammogram, colonoscopy, regular check ups. All I hear are excuses- makes no sense to me.
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I don’t know. My wife’s and my own health insurance plan don’t require us to do anything. There are supposedly 5654 health insurance companies registered throughout the US. Add the 10% of the US population without insurance and your experience may be an outlier. Certainly, the insurance companies are not allowed to coerce a patient to do anything.
Different people have different reasons…too busy, lazy, and IMO fear is a big one…fear of finding out bad news, fear of being weighed/being told to lose weight (there is a movement in medicine to stop weighing people during visits (unless having that data is important) to try to make the visit more palatable), etc.
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Could it also depend on the definition of “preventive care” varying from one plan to another?
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If people could just understand that just drinking enough water helps with body weight control, kidney function, digestion, sleep, joint health, blood pressure, bowel movements, etc., then their health could/would improve. But we don’t drink enough water.
I have friends in Ontario who are having a hard time getting a mammogram promptly.
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If your healthcare plan puts emphasis on prevention, your insurance might have capitated payment. This means physicians are paid a set fee per patient per month. If they spend more, they don’t get paid. If they spend less, they save, providing incentive to practice preventive medicine, especially in order to keep patients out of the hospital.
Capitation can also give doctors reason to address multiple problems in one visit, provide tele-health, avoid unnecessary testing etc. It has potential downsides, of course, and it is a risk if healthy patients do not balance out patients who need expensive care.
The aspect I like best about capitation is that it encourages evidence based medicine. We need more large, well- designed clinical trials of many treatments, interventions, and screenings. It helps rule out ineffective procedures.
In general, preventive care is not cost effective for insurance companies. It is highly unlikely that a person who is developing heart disease, cancer, insulin resistance, etc. will still be insured by the same company when they get sick. Under capitation, at least it is cost effective for physicians to get patients to stop smoking, address mental health, lose weight, exercise, etc. because their need for care will go down.
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Exactly. An insurance plan may prevent a heart attack 5 years from now using preventive care but with all the insurance switching that goes on, that patient is likely to be insured by a different company 5 years from now.
And overall, many types of preventive care don’t save a society money. Let’s say preventive care prevents a fatal heart attack at age 70, and that person goes on to live to 90. This prevented heart attack actually loses a society money, because this person will then need 20 years more worth of health care expenditures. From a pure cost perspective, having people die shortly after they retire is actually very cost effective, gruesome as that sounds.
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They said that about smokers. It was cheaper from a health expenditure perspective because many would die early and quickly from cancer before they got old and consumed even more care.
My husband’s company self funds its health insurance. It incentivizes preventative measures because healthier employees take less time off work and cost the company less in both medical insurance and paid time off.
How’s it’s done is the company will fund more of the employees cost if the employee gets regular checkups and reports in. They also pay for smoking cessation. They used to pay for gyms and other activities but it got controversial so that ended.
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If I think about friends and family who don’t do much in the way of preventative care, I think the top reasons are (as you said) fear of bad news and fear of being shamed and judged as well as busyness and general exhaustion. I think lazy is an unproductive label in most cases. The other reasons that I hear include:
- Not having a primary care physician
- not having a PCP easily accessible or not having transportation to get there
- Not being able to get time off from work to go to the doctor
- difficulty scheduling appointments (including not having enough break time at work to call and be put on hold in order to make an appointment --though this has gotten better at some practices which allow you to schedule your appointment online rather than having to make a phone call)
- Not being able to find child care for the appointment time
- fearing that the physician’s recommendations will be too difficult or expensive to implement
- mental health issues like untreated depression or phobias getting in the way of physical care
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My kid has a genetic mutation that is responsible for her present breast cancer.
She asked us to be tested and we did, as expected it runs through my husband. He also has this mutation. He has a higher risk of cancer (the risk is less for males) but since cancer is so prevalent in his family, at least now he can be screened and insurance will pay.
The crazy thing is how uninterested the rest of his family is in being tested. All have children who could be affected. Female children who have a much higher chance of developing breast and ovarian cancer. That close family members died of.
But still the answer is, yea I should probably do that Seemingly no curiosity of figuring out what side of the family this came from (both of my husband’s parents are still alive).
And the testing, it’s free to them. No cost because a close family member has the gene mutation.
SMH