Discussions about the complex, multi-layered challenges related to health and health care often miss or fail to adequately address some of the large-scale pressure points health systems face.
Rising costs, lack of access to care and stakeholder misalignment prevent Americans, health care systems and the health care industry from being as healthy as possible. These issues are manageable. But it will take hard work, intention, patience and a willingness to collaborate to solve the challenges we face.
Rising Cost of Health Care
In recent years, several factors have led to increased health care costs for patients, providers, health systems and payers. Those factors include but are not limited to:
A growing older adult population
Global supply chain issues
High rates of chronic disease
Some of these cost increases are justified and necessary. For example, higher wages often reflect increased job complexity. Similarly, increased labor costs may be a response to a community’s need for additional highly-trained clinicians and other health care staff. However, other rising costs may highlight areas of concern.
Patients paid for about 9.7% of the $4.1 trillion spent on health care in the U.S. in 2020. That’s equal to nearly $398 billion. It’s no surprise roughly half of American adults struggle to pay for their medical care. Worries about cost can lead people to skip preventative care, needed specialty care, or medication. In turn, this contributes to the number of people with chronic conditions.
Many employers and health systems are engaged in initiatives to increase team members and community health while lowering the cost of care, such as St. Luke’s Health Corporate Solutions’ corporate well-being services. These initiatives are essential to overall community health. Still, they do not adequately address rising costs or other pressure points facing patients, providers, payers, or health systems.
Access to Care
Health and health care are more than what happens within the walls of a clinic, hospital, or pharmacy. They are a complex collection of personal, economic, environmental and social factors that affect the well-being of individuals, families and communities.
At St. Luke’s Health, we believe all people should have the care and resources they need to be as healthy as they can be. This idea is called health equity.
Access is a vital part of health equity and comes in many forms, including:
Ability to pay for care or access financial support
Community resources that promote good health
Good communication between patients and health care workers
Transportation to get to appointments
The COVID-19 pandemic put a spotlight on existing issues related to access to care. Health care disparities between age groups, ethnic and racial groups, rural and urban communities, people in different financial situations and people with or without disabilities were highlighted. It also showed that we can come together to find effective, innovative solutions when we are motivated to do so.
During the pandemic, payers and providers came together to ensure necessary telehealth services were covered by insurance. Community members and providers partnered to bring health care to community centers and homes. Pharmaceutical companies worked with government agencies, health systems and community organizations to develop and distribute vaccines and personal protective equipment.
The process was challenging. But it did show what can be accomplished when different stakeholders collaboratively address a problem.
Misalignment of Incentives and Values
Unfortunately, attempts to come together to find solutions to large-scale health-related problems are often thwarted before they begin. From patients to doctors to health systems to insurance companies, each stakeholder brings different needs, goals, interests and motivations to the table. This misalignment can have significant implications. It may:
Still, misalignment does not mean that one stakeholder is good and another is bad. It simply means each individual or group is attempting to get their needs met in a way that is most beneficial and least harmful to them.
In any given conversation, negotiation, or situation, all parties involved can have the best of intentions and still not see eye-to-eye on what’s needed to solve the problems at hand. The issues come when people or groups are unable or unwilling to work together to find solutions that work for all involved.
However, as we saw during the COVID-19 pandemic, the health care industry is capable of collaboratively solving problems that transcend our differences to achieve common goals.
Coming Together for a Solution
No person, business, government, organization, or system exists independently of the others. Stakeholders need other stakeholders to succeed.
Where would health systems be without manufacturers? Where would patients be without medical researchers?
Similarly, the health of one person or one community is tied to the health of others. It will take an industry-wide effort to address the pressure points we face. The issues are complex and multi-layered and there is no quick fix. But change is possible. If we dedicate ourselves to the shared mission of improving the overall health of our nation in a collaborative way, we will reduce health care costs, increase access and allow for the reinvestment needed to keep our nation healthy for generations to come.