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Expert Insights
April 27, 2020
2 min read

An Ailing Patient - What next for US Healthcare?

Leon Sentker

Gene Miyamoto is back and discussing some of the most pressing issues around the U.S. #healthcare system.

Gene Miyamoto sits down with us to discuss best practices for success in the troubled American Healthcare Sector.

Gene Miyamoto is a healthcare industry veteran having held the position of COO at Alliance, Ascension Health and Infirmary Health. With over thirty years of experience in the industry, Gene has seen drastic change in his time.

What next for US healthcare?

The U.S. has the highest healthcare costs in the world and as a result, more than 28 million people are unable to access affordable health insurance.

Even with a nationwide increase in employment rates and a decrease in poverty rates to 11.8%, the Census Bureau has found a significant increase in the number of uninsured Americans.

This data points to the fact that despite the evident rate of economic expansion in the U.S, it is not enough to sustain benefits across the entire American populace.

Given the stakes at hand, namely America's ageing population and the expense of medical research and provision, this topic has proven to be divisive - among politicians and healthcare providers alike.

Historically, Medicare paid for healthcare incentives in such a way that encouraged the volume of services, rather than value.

"Navigating and investing for an opportunity in this complex U.S. healthcare industry requires informed and thoughtful strategic direction."

Both the Trump and Obama administrations have attempted to reverse this by committing to programmes that tied Medicare hospital payments to measures of quality over quantity.

However, the question of how different programmes should define 'value', 'quality' and degree of economic risk-bearing between Medicare, insurers and providers, has prevented the establishment of a fair, affordable and universal approach to healthcare.

"The U.S. spends approximately 18% of its gross domestic product (GDP) on healthcare, versus 12.2% (2018) in the next closest country, Switzerland and 9.8% (2018) in the United Kingdom.
"In the U.S. that spend is projected to rise over the next 8 years to nearly 20% of GDP or US$6 trillion. Stakeholders, the U.S. government, employers, unions, insurers, providers and patients, all struggle within this ailing system.”

Gene added that:

“While the total cost of U.S. healthcare is rising, driven by, demographic trends (ex. ageing “Baby Boomers”), clinical technology (ex. surgical robotics), pharmacy pricing, lack of malpractice tort reform, electronic health records installations, U.S. healthcare providers (ex. hospitals and physicians) project revenues to continue to drop significantly. "
"This is mainly due to aggressive insurance company contract demands and payment denials, governmental and private insurer economic risk-bearing shifts to healthcare providers, and advances in clinical shifts from hospital inpatient to lower revenue outpatient care. "
"High performance integrated health systems will succeed through improved: population health; patient safety; evidence-based medicine; case management across the entire continuum of care; and advances in telemedicine, clinical robotics, AI, NLP and machine learning.”

So what can we expect?

"Success across the improvements mentioned can produce improved: access to appropriate care; clinical safety and outcomes; lower per capita costs; healthier communities and populations; and moderation of the U.S.’s wicked high-cost problem. "
"However, complicating and reducing the realisation of such improvements today is the U.S. being greatly divided politically and social-economically, with powerful stakeholders (ex. Trump Administration, Congress, employers, unions, insurers, healthcare providers and patients) gridlocked.
"Navigating and investing for an opportunity in this complex U.S. healthcare industry requires informed and thoughtful strategic direction”

Leon Sentker

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