The Problem

The statistics speak for themselves; in general, the US healthcare system is grossly inefficient and underperforming. Uncovering why is this so, however, is complicated. Many different causes may factor in to the state of US healthcare. For example, the US is the only developed, wealthy nation without universal healthcare coverage. This means that millions of Americans do not have healthcare access because they either have not been offered healthcare by their employers or cannot afford the options available to them. Although the ACA decreased the overall number of uninsured Americans, the Centers for Disease Control and Prevention (CDC) estimated that there are still currently 28.2 million Americans under the age of 65 without any type of health insurance coverage (Thomas, 2017 & CDC, 2017).

The lack of adequate healthcare coverage affects how, when, and where people seek healthcare. Rather than receiving early or preventative care for diseases and health concerns, uninsured individuals are more likely to wait until the disease or need has progressed to the point that seeking care is absolutely necessary. They are less likely than insured individuals to have established a relationship with a primary care provider (PCP), which means they often present to an urgent care center or emergency room for treatment. Altogether, these facts mean that, out of perceived necessity, they are seeking the most expensive treatment option for a potentially advanced illness or disease, when it could have been potentially more easily and economically had they been able to seek regular care from a PCP (McWilliams, 2009).

Another contributing factor to the low efficiency of healthcare in America is its extremely high cost. The US spends more money per capita on healthcare than any other developed nation, but the spending lacks efficiency. Roughly 30% of all medical costs are due to unnecessary, wasteful medical spending. This spending is partially influenced by patients’ medical preferences and requests; many patients want to have specific tests and procedures done because they believe them to be necessary, when the reality is that those tests and procedures may not be medically indicated in their case. Providers often agree to these unnecessary expenditures to appease anxious patients or simply save time in having to explain why the tests are not called for. Physicians sometimes also order excessive diagnostic testing to avoid being held liable for any missed diagnoses, even when the patient’s presenting problem would not normally require extra testing. Finally, sometimes providers order repeat testing for their patients when the original tests were performed at facilities other than their own, simply because they feel it would take too much time to track down the patient’s original results (Sabbatini et al., 2014).