5 Myths of the U.S. Healthcare System

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November 13th, 2012

healthcare mythsIn order to improve the overall healthcare system and create informed consumers it is necessary to negate the common myths surrounding the US healthcare system.

Many healthcare myths over-simplify the complexity of an industry that generates $2.7 trillion each year and employs 16 million Americans. Other myths try to place blame for problems within the system or arise from a lack of understanding of care delivery and cost drivers within the industry. Below we highlight 5 of these commonly held myths about the US healthcare industry and provide some insight into why they simply are not true.

 

Myth #1: The Major Driver of Healthcare Costs is Unhealthy Lifestyles

Fact: While risky and unhealthy lifestyles contribute to health problems and healthcare costs, other causes, such as our fee-for-service payment system that rewards high volume of care and testing is a much more influential cost driver. For more information on cost drivers in our healthcare system take a look at our previous post: 10 Drivers of Unsustainable Healthcare Costs.

Myth #2: The Insurance Industry is the Problem

Fact: The insurance industry is an easy scapegoat for the multitude of problems facing the US healthcare system, but it is only one variable. With an industry as complex as healthcare, it is impossible for one entity to be responsible for all of the issues relating to cost, access and delivery of healthcare. The insurance industry often does not get credit for leading the way in evidence based care, transparency in cost and quality and driving the innovation of various payment and care delivery models. With the passage of the PPACA, transformation of the industry is certain.

Myth #3: More Care is Better Care

Fact: Contrary to popular belief, more healthcare does not mean the care you are receiving is better care or that outcomes may be improved.  Too much testing can uncover health problems that could have healed on their own, and may cost an incredible amount of time and money. For example, a recent study states that allowing observation time for children with head injuries can halve the need for CT scans without compromising care. Importantly, it also limits their exposure to radiation and it’s harmful risks.

Myth #4: More Expensive Care is Better Care

Fact: Healthcare consumers have an unspoken belief that more expensive healthcare equates to ‘the best care that can be provided’. Study after study has proven that healthcare quality and price have no direct correlation. In most cases, more expensive care really means wasted resources and money. Consumers use price (when available) as a benchmark because they lack information and metrics relating to the actual quality of the services they seek. Without both cost and quality information, it is impossible for consumers to determine what is really important- value.

Myth #5: The Uninsured have Good Healthcare through the Emergency Room

Fact: Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to provide emergency medical screenings and stabilization to people who come to the hospital. Emergency room care does not cover preventative care or treatment of a non-emergency medical condition. So what is an emergency medical condition? The law defines it as a medical condition with acute symptoms of sufficient severity that the absence of medical attention could result in serious jeopardy to health, serious impairment or serious dysfunction. In other words, if an individual suffers a heart attack, the hospital is required by law to provide immediate care to stabilize the patient. The hospital is not legally obligated to provide any follow-up procedure, pharmaceuticals or treatment for chronic conditions that caused the heart attack or that may prevent another.


2 Comments

  • deb from CT says:

    Sadly, all of the above is true. Even with healthcare reform, I don't see it changing any time soon. But on the provider side, if we cut payments to them any more, they will have no reason to practice (my husband is a dentist who is losing his shirt).

  • On your final point, just because hospitals are required to provide emergency treatment does not mean they have to do it free of charge. While many uninsured patients lack the financial resources to pay their own bills, up to 35% are eligible for financial assistance through State and Federal programs.