There is a cost crisis in medicine: the health care industry accounts for about 18 percent of the GDP in the United States, and predictive models see this increasing in the coming years. This is a problem for the country as a whole as an estimated 41 percent of working Americans have some level of medical debt.
Because this is an election year, many say that a change in power will fix this problem, but no matter your political beliefs, a change in executive leadership is not enough. In addition to going out to vote, medical students must do more. As students, we have the ability to influence both our patients and superiors. We have the power to change the next generation of medicine. Although there are many reasons for our bloated health care costs, medical students are in a unique position to influence how our health care system functions in the future.
Forty percent of students did not understand the basic principles of the Affordable Care Act in 2010
In medical school, we spend years learning about the vast intricacies of the human body, but little time studying how the health care system works. This may be partly the fault of our institutions and accrediting bodies, who prioritize our knowledge of the Krebs Cycle over how a patient will afford their insulin injections. However, we have an incredible opportunity to create change if we choose to learn beyond our institutional curriculum.
It is our responsibility to recognize that medicine is not just about cells and pathology but about human lives, and these lives are greatly influenced by the ability to access medical care for an affordable price. We must take the time to learn about the health care system that, pending massive structural changes, we will inherit. Books by physician-writers, including An American Sickness by Elizabeth Rosenthal, The Price We Pay by Marty Makary, and The Long Fix by Vivian S. Lee all contain important takes on the issues and conversations in our health care system — including price transparency, the insurance industry, pharmacy benefit managers, and medicare-for-all. It is from these studies that we can grasp the reasons that brought our nation’s health system to the place it is today, and start to foster creative solutions for a better tomorrow.
One-third of health care spending is waste
During rotations, we are tasked with learning evidence-based practices for prescribing medications, ordering tests and undergoing procedures. This gives us a great opportunity to not only learn when procedures and tests are indicated, but assist in the battle against unnecessary treatment strategies that don’t follow current guidelines.
While I don’t believe it is advantageous to question our preceptors for overtreating, as medical students, we can provide extra checks in the health care system. Instead of challenging, we can ask our attendings what the indications are for one treatment course over another. Something as simple as this could lead the physician to think about the various reasons they are prescribing such a treatment plan. This way, medical students are able to both learn and help curb some of the waste we see in the health care system.
Eighteen percent of visits across the US result in at least one surprise bill
In addition to educating ourselves about health systems, medical students can work to educate our patients about their ability to demand transparency within the health care market. While there have been recent advances in health policy that improve transparency in medical billing, patients still need to have the knowledge to benefit from them. Patients should be aware of their ability to ask what a procedure or office visit will cost them. They should not have to stand for surprise billing that can lead to years of paying off medical debt.
In addition to knowledge about transparency, patients should know of alternative models of care — including retail medicine and direct primary care. For example, the Surgery Center of Oklahoma City lists cash prices for procedures online so patients can shop for a fair price. Medical students can educate patients about these alternative models of care. This can empower patients to take control of how they are spending their health care dollars.
“Ninety percent of the nation’s 3.5 trillion in annual health care expenditures” are for chronic disease
As physicians in training, we often spend more time with our patients than our busy attendings. This gives us the opportunity to get to know our patients’ lives and counsel them on the importance of prevention. Benjamin Franklin said many years ago that, “an ounce of prevention is worth a pound of cure,” yet this is often lost in our fast paced and overwhelming health care system. Heart disease and stroke alone end up “costing our health care system $214 billion per year.” If we began to educate ourselves, and then our patients, about improving their lifestyle choices, we could eliminate a large share of the health care costs we see today.
The mean hospital cost per readmission can be higher than the initial hospitalization
In a recent interview on Leading the Rounds Podcast, Dr. Brent James, who has been one of Modern Healthcare’s “50 Most Influential Physician Executives,” said that while some health care problems are unique to the U.S. health care system, failures in care implementation are not. James says that if we were able to create quality systems that were up to par with the advances seen in medical science across the world, we would vastly improve both the cost and quality of our medical care.
Quality improvement projects can be as simple as increasing hand washing among health care workers, but they can drastically improve patient outcomes and cost. In the hospital, we should have our eyes open for simple fixes to the common problems we see around us.
I often hear from my preceptors that “the system is the problem” and there is nothing we can do about it. Contrary to this opinion, the system is only able to run if we as the next generation of physicians agree to be a part of it. Instead, we can and must demand change. We have more power than we know, and it is our responsibility to take advantage of this power because the physical and financial health of our patients depends on it.