The Impact of Quality and Prevention

In examining the paradox of healthcare in America, the impact of quality and prevention cannot be overlooked. In the US, 50% of healthcare expenditures are spent on only 5% of healthcare users. Fitzpatrick et al. (2015) called these individuals “high-cost users” (HCU). As it turns out, whether or not an individual is a HCU is heavily influenced by sociocultural factors. HCU tend to have lower incomes, lower education levels, and difficulties ensuring they will have adequate food and housing. This suggests that in order to address healthcare spending extremes, the US needs to focus on treating the root of the problem—poverty and lack of education—rather than simply the symptom of overspending (Fitzpatrick et al., 2015). Preventing the circumstances from which HCU’s tend to arise is difficult because it is a complicated, multi-faceted problem. However, it seems unlikely that the healthcare problems in the US will be made better until these problems are also made better.

           Providing high quality preventative healthcare has been shown to reduce hospitalizations and healthcare spending. For example, at one retirement community, physicians chose to limit themselves to only 400 total patients (most PCP’s see well over one thousand patients). Their lowered number of patients allowed them to see their patients quickly and spend more time with them, addressing their health needs and providing patient education. As a result, their patients experienced fewer hospitalizations than the national average. Their readmission rate (needing to be admitted back to the hospital within 30 days of being discharged) was less than half the national Medicare average. Clearly, when those physicians focused on providing quality primary healthcare to all their patients, it resulted in better care and significantly decreased health expenditures (Schimpff, 2010).