Challenges of Delivering High-Quality Healthcare

While the U.S. has some of the best hospitals and medical schools in the world, our healthcare system is fraught with systemic issues that limit access to quality healthcare and ultimately compromise public health.

Over the past few years, the pandemic has brought a new level of attention to the flaws in our health infrastructure. But in order to make improvements, we first need to understand the most crucial areas where our system is lacking, including poor patient outcomes, a lack of access to care, the shortage of health professionals, and soaring cost of services.

Read on to learn about some of the U.S.’s most pressing issues of which healthcare leaders and legislators should be aware.

Michal Tzuchman Katz, MD is the co-founder and chief medical officer of Tel Aviv-based medtech company Kahun. She began her career as a software engineer, but later decided to go back to school to pursue her dream of studying medicine.

In 2018, she partnered up with peers from her tech days to start Kahun, merging her two vocations. The company’s clinical reasoning software aims to optimize physicians’ time, focusing on the U.S. market. Dr. Katz continues to practice as a pediatrician in primary care and emergency settings.

Courtney Gray Haupt is the U.S. health sector chair of international communications firm Edelman. Gray Haupt helps educate policymakers, healthcare providers, and advocacy groups on drug pricing, mental health, cardiovascular disease, and patient access.

Prior to joining Edelman, Gray Haupt served as vice president of government affairs and communications for Washington Health Advocates, where she focused on coalition building and federal appropriations strategies for NIH, CDC, and FDA. Edelman recently released its 2023 report, which surveyed 13,000+ people across 13 countries about their trust in healthcare.

Patient health outcomes are perhaps the most important indicator of the functionality of any health system. Using this metric, it’s clear the U.S. has a lot of room for improvement.

Compared to ten high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom), the U.S. has:

• The lowest life expectancy
• The highest chronic disease burden and an obesity rate
• The highest number of hospitalizations from preventable causes, and
• The highest rate of avoidable deaths

The question of why the U.S.’s health outcomes are so poor compared to other wealthy countries is not easy to answer. But experts believe a major culprit is the lack of access to preventative care.

Preventative care refers to routine services such as screenings, check-ups, and patient counseling to prevent illnesses, diseases, or other physical or mental health problems. It is a key component to long-term health.

“Higher rates of chronic diseases in the U.S., diabetes, heart disease, drug addictions—these are diseases that need to be addressed in a public manner,” says Dr. Tzuchman Katz.

“Patients with chronic diseases need to [have their symptoms] identified to predict the risk of them developing further complications.”

Without proper preventative care, health issues can develop and turn into much larger problems and even lead to preventable deaths. This brings up another issue, which is related to access.

Americans typically visit the doctor four times a year per capita, which is half the rate of comparably wealthy countries like Germany and the Netherlands. But it’s not due to neglect or laziness: it’s largely because of lack of access to care.

In the U.S., it can take months to see a primary care doctor and even longer to see a specialist in certain geographic regions; rural areas can have especially long wait times.

Not only do patients not see their doctors often enough, but even when they do, they need to be examined more thoroughly. In other words, access to care is both an issue of quantity and quality.

More than half of American primary care physicians say they spend just nine to 16 minutes with patients. This is hardly enough time for a doctor to gather all the necessary data about a patient and get a full picture of their health, especially when visits are few and far between.

A 2017 study found that 85 percent of physicians wish they could spend more time with their patients and most agree that the demands of their practice often prevent them from spending as much time with their patients as they would like (83 percent).

This leaves little time for physicians to build rapport with patients which can further thwart the opportunity for patients to disclose valuable information about their health and symptoms.

“Healthcare leaders—whether those engaging directly with patients or those at the organizational level—must recognize building trust and changing behavior is contingent on transparency and open communication,” Gray Haupt says.

“People want to know recommendations are grounded in diverse research and they want to understand the data and what it means to them personally. They want to feel that their questions and concerns are addressed in meaningful ways.”

Without open dialogue between providers and patients, warning signs and symptoms can slip through the cracks, allowing a person’s health to decline and ultimately compromising care outcomes.

Another factor that contributes to poor health outcomes is the severe shortage of healthcare workers in the U.S., which spans occupational niches.

Various data reporting organizations have attempted to quantify the deficit. The Association of American Medical Colleges estimates that by 2034, there will be a shortage of 37,800 to 124,000 physicians. And according to data from McKinsey, there will be a shortfall of 200,000 to 450,000 registered nurses available for direct patient care by 2025.

Nurse practitioners (NPs), physician assistants (PAs), and physical therapists are also expected to be in short supply.

Healthcare economists have been warning about this impending supply and demand issue for decades, mainly in anticipation of the aging of the Baby Boomer generation, who have now reached the age that they need more medical attention.

“The growing populations who need the access to care and the complexity of care that they need is really the main factor that drives this shortage of staff,” Dr. Tzuchman Katz says.

In early 2020, more than half of nurses reported insufficient staffing at hospitals. This stems from the fact that most states have no regulations to mandate nurse-to-patient ratios, allowing hospitals to hire fewer nurses and save on labor costs.

This short staffing trend made for a shaky foundation when the chaos of the pandemic ensued – the influx of patients and lack of personal protective equipment, adding to the mounting pressure on healthcare workers. For many, the pandemic was the straw that broke the camel’s back.

During the height of Covid, a whopping one in five healthcare workers left their jobs and surveys suggest that nearly half of healthcare workers plan to do the same by 2025—stress and burnout being the major driving factors.

Cost is an unignorable issue plaguing the U.S. healthcare system. According to a survey from the Kaiser Family Foundation, nearly half of American adults say it’s difficult to afford healthcare and 41 percent have medical debt.

“The U.S. spends more money—more cash—per capita than most Western countries [on healthcare],” Dr. Tzuchman Katz says.

Nearly four of 10 Americans reported delaying care in 2022 for fear of high medical bills—the highest percentage since Gallup began tracking this metric more than 20 years ago.

So, why exactly is American healthcare so expensive, especially considering our subpar healthcare outcomes? There are multiple factors at play.

Many are aware that pharmaceutical companies have the freedom to set prices of medicine, which is certainly a major contributor to out-of-control costs. But there is a deeper, often overlooked problem enabling the capitalist nature of our system, which is the U.S.’s fee-for-service (FFS) structure.

In FFS systems, providers make money based on the quantity and type of services they provide. This is part of why American healthcare utilizes expensive technologies, such as surgeries and specialized procedures more often than peer countries. But this approach does not always equate to better health outcomes.

Profit-driven healthcare can disincentivize preventative care in favor of overuse of expensive “band-aid” fixes. Studies show that wasteful care can account for up to 30 percent of healthcare costs.

Systematic disparities in healthcare go back to the inception of the U.S. and continue to affect marginalized communities in a very real and tangible way.

Healthy People 2030 defines a health disparity, as “a particular type of health difference that is linked with social, economic, and/or environmental disadvantage.”

Communities of color, i.e. Black, Latino, and Indigenous and Native American people, Asian Americans and Pacific Islanders; members of religious minorities; LGBTQ+ individuals; people with disabilities; and people who live in rural areas are disproportionately affected.

There are countless harrowing statistics that measure these discrepancies in access to care and quality of care.

• Average life expectancy among non-Hispanic black Americans (75.3 years) is 3.5 years lower than for non-Hispanic whites (78.8 years).
• Black, Hispanic, Asian, Native Hawaiians and Pacific Islander people are all less likely to have health insurance compared to non-Hispanic whites.
• LGBTQ+ people are also less likely to have health insurance than non-LGBTQ+ individuals and more likely to delay getting care.
• Among adults with any mental illness, Black (39 percent), Hispanic (36 percent), and Asian (25 percent) adults are less likely than white (52 percent) adults to receive mental health services.
• Maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic white women.
• Black infants and American Indian or Alaska Native infants are twice as likely to die as white infants.

These are just a few examples of the ways that marginalized communities are affected by healthcare disparities.

The pandemic and Black Lives Matter movement have prompted many to wonder about their underlying causes of health inequity and what can be done to finally address it.

Experts believe that racism, discrimination, and implicit bias on behalf of individual healthcare providers still drive disparities. For example, studies have shown that Black Americans are undertreated for pain compared to their white counterparts and, if given pain medications, they receive lower quantities.

Systemic issues such as residential racial segregation—a result of Jim Crow era housing discrimination – are also to blame for perpetuating healthcare inequity. People of color are still more likely to live in neighborhoods with concentrated poverty where hospitals and health centers have less resources.

The lingering effects were observable during Covid when it became apparent that low-income neighborhoods had fewer Covid testing sites and hospitals were allocated fewer essential supplies.

While legislation can play a major role in forwarding change, Gray Haupt says that healthcare leadership also shares responsibility.

“Healthcare organizations must continue to address the societal issues and inequities that disproportionately affect those with lower access to affordable care,” she says.

There is still a lot of work to be done to address pressing issues in U.S. healthcare. While the complexity and interconnectivity of issues can be daunting, change is possible.

“Our research found that most people believe businesses should do 5 things to improve people’s health globally,” Gray Haupt says, “Provide trustworthy information, address the societal factors making us sick, focus on local and community engagement and convene stakeholders to improve healthcare together.”

As Gray Haupt says, improvement must be a group effort.

To address staffing shortages, healthcare administrators, policymakers, and learning institutions must put more effort into attracting young people interested in healthcare careers, and importantly, rewarding those who stick around.

Safeguards must be introduced to regulate the profit-driven aspect of our healthcare delivery system. There is a push to transition to alternative models, such as value-based care, which incentivizes providers to prioritize quality of care over quantity. However, this movement is still in early stages.

AI-based technology is a promising boon to suffering patient care outcomes. Medtech companies like Kahun, co-founded by Dr. Tzuchman Katz, aim to optimize the time doctors spend with patients by moving time-consuming processes like documentation and data collection to a digital interface that can be completed before a patient’s appointment.

Dr. Tzuchman Katz also says that AI also can improve patient outcomes by aiding physicians with the diagnostic process, meaning patients can be correctly diagnosed sooner and receive proper treatment more quickly.

The good news is, public awareness of these systemic issues is on the rise and healthcare stakeholders are getting involved in conversations about solutions. If harnessed, this collective interest could lead to meaningful change in the nation’s approach to healthcare.