The Health Care Paradox

written by Christopher Costa

edited by Haley Welch and Adrienne Suhm

The United States government spends 17.8% of the nation’s GDP on healthcare. This equates to around 3.2 trillion or an average of about $10,000 per person.[1] However, we rank 11th out of the Commonwealth Fund countries in healthcare performance and 31st in life expectancy. The incidence of infant mortality, chronic disease, and drug-related deaths are higher here than in other developed nations around the globe. In fact, the current American drug problem is so widespread that it has recently become classified as a national epidemic.

We spend the most, yet have the poorest healthcare system performance. What a frustrating, and expensive dilemma. We believe our nation to be exceptional. We believe that America is “number one” in every category, even when health statistics show otherwise. Where are the exceptional healthcare outcomes that we expect to see from a nation abundant in both wealth and resources?

Our first response is to blame poor performance on economic and racial disparities. Although these disparities do exist, even stereotypical white, wealthy, college-educated, and insured Americans are still worse off than those with similar socioeconomic characteristics in other countries. It is also easy to point fingers at insurance companies for greediness, pharmaceutical companies for setting unfathomable drug prices, hospitals for charging unnecessarily exorbitant fees for overnight stays, and the fee-for-service model for encouraging some physicians and hospitals to order insignificant yet expensive clinical tests for personal profit. As these cases are the unfortunate reality of our everyday healthcare regime, combatting these quandaries is imperative. However, the root of this paradox begins before the patient even enters the system and is inefficiently addressed when they do. The latter of the issue, I will address below.

After graduating with a Bachelor’s degree in Public Health, it became apparent that there is a whole panoply of socioeconomic factors that influence our population’s health. Attempting to curtail the detrimental effects of these socioeconomic factors will take community, state, and federal government involvement in numerous areas such as affordable housing and increased access to fresh food and safe parks. However, I will focus specifically on a healthcare system that is responsible for one of the largest proportions of overall health expenditure: the emergency room.

Consumers rely on the emergency room (ER) as a catch-all for any medical complications that need immediate attention, but they often bypass the first and less expensive safety net known as primary care. A universal pattern has identified observing many cases that look like this: A patient develops a medical issue that has escalated enough to need emergency attention. He or she is admitted the hospital. The chief complaint is noted, tests are ordered, and treatment is performed. Depending on the severity of the complication, the patient is discharged the same day as arrival or kept overnight until stabilized, or if space in the hospital allows; admitted as an inpatient for further care and testing. The patient will be permitted to leave after assessment, with a prescription that will hopefully alleviate the rest of their recovery.

5 days later, they’re back.

ER physicians often discharge patients knowing that although a treatment has been prescribed, they have barely scratched the surface of their underlying health problems. Discharged patients are often hesitant and scared to return to the same environment that induce their health problems with little guidance on how to make necessary and permanent lifestyle changes. The first patient is triaged for showing symptoms of a contagious infection due to living on the streets with a suppressed immune system. They hold a minimum wage job but struggle to find affordable housing. The second patient is experiencing numbness in both of their legs. They were a middle-class individual who had become morbidly obese, possibly associated with Major Depressive Disorder and a development of Type 2 Diabetes. They were neither able to find consistent mental health counseling nor proper education linking the detrimental effects of an unbalanced diet. Their third patient was a 15-year-old from the inner city suffering from a stab wound. In order to help their single mother make ends meet at home, the patient had turned to selling drugs and an exchange turned violent.

Although the ER care team collects this information during the initial assessment and carefully records each patient’s stories into the hospital database for the next shift of physicians and nurses to review, it is disheartening to learn that underlying health problems of each patient is only noted briefly in a file that is erased when he or she is discharged. These notes are barely addressed and rarely followed up on, and the same pattern occurs over and over again. The ER collects what are known as “regulars” – patients who return with the same health problems or self-induced traumas, hoping to bother the care team long enough to receive narcotics and potentially escape a poor home environment.

Fortunately, there are positions in the healthcare system to address this issue. Social workers, case managers, community resource specialists, and community counselors have a responsibility to view each patient holistically and take into consideration the influences that led to his or her encounter with the health care system. It has been proven that interventions of guidance and accountability, facilitated by these individuals, lead to countless beneficial health outcomes. The involvement of these professionals reduces the frequency of re-hospitalization and ER visits, ultimately saving millions of dollars each year. The impact they make on each patient’s life helps to reduce the risk of chronic disease, halt the escalation of medical emergency complications, decrease drug addiction, of life.

This issue must be tackled through the implementation of social services and case management programs. This is not a revelation for healthcare systems, but establishing the most efficient and cost-effective plan to expand these fields will be extremely challenging. Although the healthcare positions listed above do not result in the most lucrative career paths or revenue-generating services, they debatably offer the most valuable solutions to producing beneficial health outcomes. Finding a way to increase the social work sector will require statewide and nationwide health system collaboration, but if done successfully, may be the answer to the health care paradox we are seeking. The structure of that system may already be in existence as well… The future of healthcare is here, and it is time to take advantage of this opportunity. To be continued.

This article was largely inspired by the book, The American Health Care Paradox written by Elizabeth H. Bradley and Lauren A. Taylor.