We’ve all heard about the Affordable Care Act (ACA), or as most people in America know it, “Obamacare”; and we as a nation, are mostly divided about the program. In truth, the ideal that President Obama and his administration tried to achieve is admirable, but their execution is largely flawed. The critical missing ingredient, the regulation of the third party payers.
Our Broken System
Our healthcare system is built upon a divided set of smaller industries. We have hospitals and doctor offices, medical devices, pharmaceuticals, biotechnology, pharmacies, and largest of all, insurance companies. All of these business entities are operated, as well as governed, independently. While independence of each other may work well in regulation, it does not work well when we are speaking of the benefit to the end user. Multiple industries all having a part in the overall healthcare of the patient means multiple times the cost is driven up in order for each industry along the way to make a profit. That also means multiple opportunities for companies to focus on the business over patient care.
Do the industries even care?
The further separated from direct patient care you go, the more likely you will see a larger focus on profits, than on patient well being. This is not to say that the bigger players don’t care about the patient, they do, but their greater focus is not the individual patient, but on the patient population as a whole. For instance, point of care facilities like doctors and pharmacies focus on each individual patient and how they can help improve their quality of life. Higher up the ladder, the train of thought changes. Pharmaceutical companies may think of how shifting trends in patients’ health can help them to shift their focus on specific treatments and therapies to increase their drug pipelines. Even higher, you have insurers that will look at shifting trends in medications and therapies and how they can minimize their expenditures while still providing a patient with a baseline standard for care. I don’t believe that what these industries are doing is inherently wrong, after all they are a business and their primary focus is on their shareholders, not the patients. That being said, I do believe we need to change the system and find a way that benefits both the patients, as well as the shareholders.
The United States is at the center of a healthcare crisis. We are one of the most obese and unhealthy nations in the entire world, and our healthcare system is also one of the most flawed. A large majority of those living in the US do not have access to quality health care, and worse, the systems in place to provide healthcare for the poor are not being utilized correctly, which in turn fuels the negative cycle. All across the nation we see patients on Medicaid treating emergency rooms like a doctors office because it’s simply easier than making an appointment at a doctors office.
The solution is a difficult one, and may ultimately prove impossible. While a regulating body for insurance companies based on evidence based medicine may be the easy way out, it’s not likely going to happen in our society. Perhaps a better solution is one we are already seeing in the industry. Pharmaceutical companies are changing the way they develop and market drugs to incorporate market access in their decision planning, making even the newest drugs more accessible than before. We also see retail pharmacies creating new patient focused services such as medication therapy management, which provides medication reviews and consultations to patients. The focus is on reducing the need for costly treatments and procedures, while proving to third-party payers that we did our best to maintain the health of an individual, so now the therapy we are proposing is the most logical and reasonable conclusion. Yes, the ACA is flawed, but with proper adaptation by the various industries, there may be a light at the end of the tunnel.