According to a report published by the researchers at The Dartmouth Institute for Health Policy & Clinical Practice earlier this year, evidence-based research has declined in the U.S. health-care system and corporate greed has degraded the entire system.
Health care is a prominent global industry, a key responsibility of the government as well as businesses, but more than that, it is an essential human right. However, certain financial forces such as insurance companies, hospital networks, and regulatory groups are beginning to corrupt care and undermine the bond between doctors and patients.
Pay-For-Performance Medical Contracts
Pay-for-performance schemes are widely used by private payers and Medicare in the U.S. to improve the quality of health care and reduce costs. However, there’s little evidence whether or not these criteria actually improve quality or do any good to patients.
As per such policies, physicians are directed to meet stringent metrics for testing and treatment. But, these metrics don’t take into account the individual characteristics and preferences of the patient or differing expert opinions on optimal practice. Instead, they’re generic and population-based, which is why they are ineffective when it comes to improving patient outcomes. Say for example even for the most simple of pain that can be cured without much of medication, doctors will suggest a list of opiates, which on long term basis can cause serious health issues.
Perhaps, this is the reason why the report by the Commonwealth Fund shows the U.S. health-care system is the most expensive in the world. However, when it comes to health outcomes, the industry performs worse than 11 other industrialized nations in terms of health access, efficiency, and equity.
Physicians who achieve their targets are not only rewarded with a bonus from the insurer but are also given high ratings on insurer websites. Physicians who deviate from such metrics, on the other hand, are financially penalized through lower payments and can suffer from poor ratings on healthcare review sites.
Situations, where the patient visits a doctor with a minor health issue and comes out with huge medical bills, have become common these days and there is still no proper solution to curb this situation. Lack of awareness among patient adds to these and works in the advantage of such physicians who involve in such practices.
In case of travelling that’s becoming even more important to check if the country you are staying is part of medicare reciprocal agreement countries. For example, when you’re an overseas visitor or relocating to Australia, it’s important that you find out if you will be covered by Medicare, otherwise even in a public hospital you could be charged more than $1,000 a day in hospital fees alone.
Insurers Dictating Medications
Playing the insurance game has become an uphill climb for the patient.
Medical insurance are to help patients when in need of urgent money, but the monopoly in health insurance sector has forced us think if is good for a patient or not. The terms and conditions specified in the medical insurances forces a patient to use health services not as per needed by him but as per the requirement of health insurance companies.
WellPoint, one of the largest American health insurance companies, recently outlined treatment pathways for cancer. The company further announced that it would pay physicians an incentive of $350 per month for every patient treated as per the designated treatment protocol.
WellPoint is just one among the several insurers who are offering a positive financial incentive directly to physicians for using specific medications. This is leading to a scenario wherein patients may not get the health treatments that are best for them. Instead, they may get those which the insurance companies think might be right for them.
Medical Research Influenced by Financial Incentives
According to the report produced by The Dartmouth Institute for Health Policy & Clinical Practice in 2015, the pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behaviour that influences how medicine is practised.
The report further emphasizes how finance is playing a far more important role than the rigorous scientific process in medical research at present. Drug trials that show positive results are quickly published and promoted, while the results of trials that do not show beneficial effects remain unpublished or are suppressed by the sponsors. Suppressed data related to ineffective drugs and devices may endanger patients who are subjects in clinical trials or who may subsequently use them for treatment.
Even today you can easily find medicines that if consumed can cause serious health problems. Many research results show just the minor positive result but hide the hazardous side effects the medicine will have on a later stage. Medicines are brought into the market based on how much profit it can generate instead of how much wellness it can bring.
Industry-supported trials dominate the medical field, with an almost exclusive focus on health problems that expand the market share.
Outrageously Expensive Medical Bills
According to the financial advice company NerdWallet, medical bankruptcy is the most prevalent cause of personal bankruptcy in the U.S. Americans pay three times more for medical debt than the bank and credit-card debts combined. Moreover, it’s important to note that those who went bankrupt because of medical bills were not those without insurance. In fact, three-fourths of those people who become bankrupt due to medical bills were covered by some form of health care coverage.
The study also concluded that 63 per cent Americans have received medical bills that were more than what they expected to pay. Worst of all – several bills were a result of hospital errors and almost half of Medicare insurance claims contain billing mistakes.
These practices are making it clear that in today’s healthcare system, power belongs to insurers and regulators who control money, and not doctors or patients. Health care is a more profit-driven industry than ever before; where patients’ interests are of little or no significance.
High medical bills aren’t only the patients’ problem. Any kind of medical facility needs to be familiar with the medical billing services in order to thrive.
Awareness is the key
Healthcare was and is always meant for the better of humanity but vested interest of few has turned it into a money-making business by playing with the life of those who put blind faith in them. There is a need of more awareness and even strict laws that can if not fully remove then at least have some control over all the wrong practices going on in the health sector. Efforts are needed not just from the Government side but also from the patient side who should become more aware of the health industry.