How American Healthcare can Recover from Decline

Lack of care can be linked to the opioid crisis currently gripping rural America.

(SALEM, Ore.) - Last year the Commonwealth Fund, an independent think tank, presented a troubling report on the condition of the US healthcare system. It found that the US had the worst performing medical system out of 11 countries with a similar economic and social profile, and was spending more money but getting poorer results.

Some improvement

The report stated that the US performs relatively well on doctor-patient relationships, end of life care, and survival rates after suffering major illnesses or health attacks (cancer, heart attacks, strokes).

Mortality rates have fallen steadily over the past 30 years, while the "burden of disease" declined by about 15% from 1990 to 2013. But the improvements, attributable to better standards of living, greater understanding of medical issues and scientific advancement, have been markedly slower than in other comparable countries.

High rates of mortality

The US has the lowest life expectancy and the longest waiting times for treatment out of the countries surveyed. It also has relatively high rates of infant mortality and the highest rate of mortality due to preventable causes.

While that rate has improved over the past decade, once again it has improved far more slowly than in other countries, including the UK, Australia, the Netherlands, Germany, Canada and France.

Hospital closures

The number of health service providers being closed down all across the country, especially in rural areas, is also a source of concern. Locally we've seen the closure of the Spaulding Rehabilitation Hospital in 2015, and the closure of Salem Hospital's cardiac surgery unit and inpatient pediatric unit, in 2016 and 2017 respectively.

In each case the Massachusetts Department of Public Health has declared these to be essential services- and then has closed them anyway.

More recently, it was announced that Union Hospital in Lynn is to close in October 2019 and be consolidated into Salem Hospital- a decision that has angered many Lynn residents.

The legalization of medical marijuana across the state certainly has many benefits, but it is no substitute for properly staffed and supported healthcare facilities.

Not worthwhile

Hospitals serving rural areas have closed at a rate of roughly one a month in the past few years. According to the Cecil G Sheps Center for Health Services at the University of South Carolina, 80 shut their doors between 2010 and February 2017.

As rural populations decline and age, it is simply not worthwhile for hospitals operating on a purely business model to stay open. Yet many of those closing are critical access hospitals serving communities where the next nearest provider is over 35 miles away.

This lack of care can be linked to the opioid crisis currently gripping rural America. With no treatment centers or drug recovery programs, the problem can rage unchecked. Hospital closures also negatively impact the local economy, which in turn affects local health, particularly in terms of the prevalence of drug misuse.

Digital technology

To some extent, patients in rural communities are being helped by the rise in telemedicine. Advances in digital technology means that doctors can diagnose remotely, seeing patients via video conferencing, with prescriptions being ordered online.

Medical information is also more widely available online. Oncotarget is a multidisciplinary free access journal publishing online every week that makes the latest scientific results available to a wide readership, allowing important discoveries to be shared quickly. This is one example of the way privately funded organizations can benefit the health system.

The way forward

The current government appears set on repealing the Affordable Care Act or "Obamacare" and replacing it with a system that relies more on private health insurance provision. That could result in insurers charging higher premiums to those most in need, while refusing to cover pre-existing conditions or certain problems.

These coverage restrictions can delay access to treatment, as complex rules mean that neither physicians nor patients know what is covered and what the charges are likely to be.

Many in American government and life are resistant to adopting a tax-funded universal healthcare model. The Commonwealth Fund however proposed a third way.

Insurance coverage should be increased and greater access to primary care facilitated, while the insurance system needs to be streamlined to make it easier to understand and to get rid of red tape.

It also proposed that more money be spent on nutrition and housing- focusing on the prevention of illness at least as much as the cure.

If a middle way between single-payer welfare and a fully private insurance system can be found, with the government regulating the insurance system and backing insurers, doctors and patients alike, maybe the decline of America's healthcare can be halted and we can look forward to a full recovery.