Health Care Reform Can Remove Barriers to Care

Reworking medicine to include prevention will take up-front spending but could transform public health

By Cora Bainum

Many people can relate to visiting a doctor for pain, discomfort, or fatigue, only to receive medication that offers temporary relief. The symptoms return a few weeks later, however, and there begins a cyclical loop of symptoms, short doctor visit, and new medication.For the six in ten Americans with chronic diseases, such repetitive and expensive healthcare cycles are all too familiar. Yet, the onset of many chronic conditions can be mitigated with lifestyle adjustments such as a balanced diet, regular exercise, and stress management.

Despite this, less than three percent of the $3.8 trillion-dollar healthcare spending is spent on public health and prevention. The prevailing U.S. health approach is curative, often addressing illnesses through costly medication and surgical procedures only after the diagnosis. Healthcare spending must shift towards preventative health to mitigate the deaths of hundreds of thousands of Americans and the extensive cost of treating long-term conditions.

Puneet Chehal, an assistant professor of health policy and management at Emory University’s Rollin’s School of Public Health, delves into the reasons behind the lack of preventative care in the U.S. healthcare system. She explains that health programs and providers need to work in tandem to address the interdisciplinary environmental, social, and economic status of an individual. However, the current lack of care coordination of health services in the U.S. prevents systems from operating together. Health policy and governance, reimbursement design, and service delivery are fragmented and often differ between the federal, state, and local levels. This fragmentation consequently leads to stagnation and growing inequities in healthcare delivery.

The non-medical components that influence health and well-being are commonly referred to as the social determinants of health. They are broad, interconnected, and are considered the fundamental causes of a wide range of health outcomes. These factors are also preventative; if these components are addressed, chronic conditions and adverse health outcomes are less likely to occur. Yet, the division amongst providers, payment systems, and an overall lack of coordination that is common in the U.S. healthcare system does not adequately address the conditions in which people are born, grow, live, work, and age. Ultimately, this leads to high rates of chronic physical and mental health conditions.

Studies from the National Institute of Health (NIH) demonstrate that financial incentives for provider collaboration can improve care coordination in healthcare delivery. These incentives may be in the form of rewards or penalizations to motivate physicians and organizations to work collectively and promote long-term patient outcomes. Connecting the providers and services that focus on the medical, environmental, social, and emotional aspects of an individual can enhance patient care and cut costs while also addressing the social determinants of health essential for prevention. Therefore, increasing spending on care coordination incentives within both the private and public healthcare sectors will enable effective preventative care and lessen illness rates.

The breakdown of public health services is further impacted by cultural norms and perceptions of said services. “The social programs in the U.S. tend to be very shaming,” Chehal says. “They are just in case you fall through the cracks. It’s temporary and you’re kind of shamed into accepting it”.

Unlike other countries’ public health programs, the structures in the U.S. are designed to be temporary and hard to access. They are a last resort option and often only address one aspect of health coverage. Chehal explains how an individual in a state with progressive attitudes towards government support systems may have some support but if they move a state over, that safety net may be revoked. A model so influenced by societal shame such as that of the U.S. cannot meet the demands of public health let alone address the interdisciplinary social determinants of health.

Victoria Phillips, an associate professor of health economics at Emory University, expands upon the implications of common perceptions surrounding healthcare delivery. She explains how the desire for a quick fix exacerbates the lack of participation in preventative care.People expect painkillers and pills to alleviate discomfort and disease because that is what’s taught and that’s what’s comforting and easy for many. As a result, it’s typical for morning and night routines to consist of a pill regimen packaged in a weekly pill tray. Yet, a mere 8 percent of Americans receive routine preventative screenings. With obesity rates at 36 percent and over 80 percent not consuming the recommended amounts of fruits and vegetables, America’s public health is at a crossroads.

“We need to move away so much from an M.D. model to more of a holistic, social work model where we really think about addressing the person’s circumstances rather than just addressing them as having an illness,” Phillips says.

There are multiple barriers preventing people from enhancing their health holistically, such as a lack of safe exercise spaces, inaccessible healthy foods, and insufficient time for medical visits due to work demands. For people who are just concerned with managing day-to-day needs, instituting behavioral changes is not always feasible nor is it a priority. A structural solution or attitude solution would not be effective. There must be an enhancement of public health services and a change in public perception of said services to effectively improve preventative care.

Implementing employee programs that pay people to have primary care visits, get vaccines, or lose weight can initiate healthier lifestyle behaviors. Bolstering P.E. in elementary schools to integrate and normalize physical activities from a young age can start long-lasting habits. Making pharmacies and doctor’s offices a place where people can educate themselves about healthy behaviors and condition management before getting a prescription can save money and mitigate chronic conditions. Developing media platforms to inform the public of misconceptions surrounding public health services can mitigate stigma. Medication should still be an option, but not the first step.

Transitioning from a curative to a preventative approach in healthcare is no simple task. There must be an improvement in care coordination as well as a shift in cultural norms and attitudes regarding public health services. However, by promoting collaboration between providers, increasing resources allotted to preventative care, and educating the public, preventative care is not impossible. These changes will take time, resources, and money, but, eventually, the U.S. healthcare system can operate off a more coordinated, preventative model saving both lives and money.