If one judges by statistics and performance scorecards alone, in the United States, healthcare means high cost and low quality.
The expenditures are enormous. Healthcare spending in the United States accounts for around 17 percent of gross domestic product (GDP), and the U.S. has the world’s largest. Other advanced countries spend between 9 and 11 percent of their considerably smaller GDPs. Historically, U.S. healthcare spending has grown faster than in other advanced countries. From 1980 until 2020, healthcare cost as a percentage of GDP doubled, but in other countries, it went up by only 2 percent. Healthcare has been a growth industry, so to speak.
Doctor compensation is uneven, and in the United States, there are some very wealthy doctors. The top 1 percent make $4.1 million per year. The top 25 percent make $871,000. The average, however, is $350,000, which is less than many computer programmers or social media workers. In high-tax states, when income and property tax are combined, $350,000 does not get very far, because the tax rate is more than one-half. So, except for a very few MDs, going into medicine is not a path to wealth. We must assume that the primary motivation at the heart of many medical personnel is altruistic humanism.
In addition, U.S. doctors have significant expenses not found in some other countries. For example, they pay big for malpractice insurance. For many, premiums range from $4,000 to $12,000 per year. But surgeons may pay $50,000 and OB-GYNS may pay more than $200,000 per year.
These incredible costs, which appear to be a phenomenon found only in the United States, have their etiology in the exorbitant litigation nightmare. In legal circles, malpractice litigation and product liability are major “industries,” and juries can be counted on to award very substantial damages.
When a number of benchmark measurements are taken into account, we see that out of 11 advanced countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom – U.S. healthcare is in last place, according to the Commonwealth Fund, which examined dozens of variables to make its assessment.
By many crucial measures, the United States gets very poor scores. It is lowest in access to care, lowest in administrative efficiency, lowest in equity, and lowest in healthcare outcomes. Also, the gap between the U.S. and other nations is significant.
It may surprise some that the U.S. ranks very low on the ability of citizens to get same-day care or after-hours care.
The United States is the only high-income country with no universal health insurance. Thirty million are uninsured; 40 million are chronically under-insured. The U.S. has the second-highest out-of-pocket expenses.
The system of private health insurance in the United States often receives acidic criticism. “Gotcha” health insurance rules surprise patients with a much higher level of claim rejection, and this often is found out after the cost has been incurred, so consequently it is passed to the patient. This is the precise opposite of what insurance is designed to do. Repeatedly, U.S. doctors have more problems getting medication or treatment for their patients, because insurance does not allow them to. This “pre-authorization” process causes major problems. Often well-known and effective off-label treatments are turned down because the insurance carrier will only approve what the Food and Drug Administration (FDA) certifies.
The management of healthcare claims and payments in the U.S. is another major headache. In comparison to other countries, U.S. citizens spend the most time doing healthcare-related paperwork. The U.S. is the only country in the world that employs an army of paid specialists to help citizens navigate the medical bureaucracy. Often, legal counsel is required, particularly when appeals against coverage are involved.
If equity is measured by how good healthcare is for a patient, depending on how rich they are, then the U.S. is by far the worst. Even its higher-income citizens have access problems equivalent to the least wealthy in the second-worst country (New Zealand). The breakdown of immigration may lead to further change. With the flood of 8 million or so non-citizens who have entered the country, once they are provided government-funded healthcare and put in the statistics, the equity picture will be much worse.
The overall results are not stellar. Far from it. In the U.S., relatively more people have a “negative patient outcome” – that is, they die. Mortality is 250 per 100,000. The next-highest country is only around 150. Switzerland is 125 – one-half of the U.S. number. Public health also has a mixed track record. For example, U.S. COVID deaths were higher than in Nigeria, which had no national vaccination program.
It is not all negative. Far from it. The U.S. has relatively high influenza vaccination rates. Its record on surgery is excellent. For example, U.S. patients experience lower rates of postoperative sepsis after abdominal surgery.
It is not an exaggeration to say that the U.S. leads the world in medical innovation. The high costs are part of the costs of that investment. High prices for pharmaceuticals finance the research and development (R&D) needed to develop new cures.
The U.S. also probably has deployed on average the most advanced medical information systems in the world. For example, the incredible investments made in computerization result in superior e-Methods for filling prescriptions. The U.S. excels in keeping track of details.
All services given to a patient, everyone involved, how much time was spent, what observations were made, the 24-7 monitoring telemetry of the patient’s condition, visitor logs, to name only a few factors. We count and measure almost everything that happens to a patient. This ocean of data will form the foundation for application of artificial intelligence to allow for big data-mining and other innovations.
In sum, the seemingly excessive expenditures on information technology are setting the stage for the evolution of smart hospitals, and ultimately, better healthcare.
The U.S. healthcare system is evolving at its own pace. It is complex, and designed to accommodate a wide range of cultural, economic, business, and political interests. It is set up to pour a significant amount of cash into investments for R&D and innovation. It could be that Americans are spending more because they are investing more and innovating more. After all, mere statistics never give the entire story. Nevertheless, if we go by the statistics and benchmarks alone, the U.S. is far from getting its money’s worth.
As many Europeans say: “the Americans always get it right, but only after trying every other option.”
Well, I gave you all a break from my criticism of insurance company policies and ploys last week, and I had planned to go for
If you are just crawling out from under a rock, note that last week, we had an election in this country. Republicans won the White
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
