According to the report, the US is a failing nation due to serious deficiencies in the healthcare system

This is the brutal conclusion of a recent study Mirror, Mirror 2024: A portrait of the failing US healthcare system Commonwealth Fund report on health care in rich countries. The report lists the U.S. as the worst-rated system overall, even though the country spends by far the most on health care.

In four out of five categories, the U.S. ranked either lowest or second worst in the survey, which compared the health systems of 10 wealthy countries. These four categories are access to health care, administrative efficiency, equity, and health outcomes.

“Most of the countries we compared offer this protection, although each has much to learn from its competitors,” the report concludes. “By failing this ultimate test of a successful nation, the United States remains an outlier.”

Where’s the incentive?

Perverse incentives play a role in such a dismal outcome, said Lucienne Ide, MD, Ph.D. and CEO of Rimidi, a remote patient monitoring company.

The U.S. health care system leaves 26 million people uninsured and even more underinsured, depriving people of access to care until the last, costly minute, she said. Furthermore, the lack of an effective primary care infrastructure plays a major role and exacerbates the comparative lack of preventative care and higher quality disease management.

“One of the great paradoxes of the U.S. health care system is that when you’re seriously ill, you don’t want to be anywhere else,” she said. “However, if you want accessible and affordable preventive care, the U.S. is the last place you want to be.”

Alexandra Tien, MD, a family physician at Medical Associates of Rhode Island, agreed that the health care sector pays lip service to the importance of primary care.

“Family physicians are the lowest paid doctors, and until that changes, medical graduates with hundreds of thousands of dollars in debt (because we don’t subsidize medical education in this country) will certainly flee primary care as quickly as they can,” she said . “As a country, we pay lip service to the importance of primary care without actually paying primary care physicians accordingly.”

Indeed, current healthcare incentives are not aimed at providing patients with the best possible care, but rather are driven by revenue opportunities, said Warris Bokhari, MD, co-founder and CEO of Claimable, an AI-powered health insurance claims company. He said insurance companies and health systems benefit from such incentives, but not patients.

“Our system incentivizes short-term profits over long-term health outcomes and makes business performance the primary measure of success,” he said. “Ultimately, the two industries – medicine and insurance – are linked only by name, leaving patients in a system that treats care as a line item rather than a liability.”

Additionally, larger health systems are increasingly buying up previously independent practices, further driving up costs for patients, Bokhari added.

Not just hospitals

The dysfunction extends across the entire healthcare ecosystem. Pharmacists and dentists experience similar complications and should also be considered when discussing the problems facing the entire U.S. healthcare system.

For example, consolidation in pharmacy benefit management and digital health highlights the issues of high costs, administrative inefficiency and lack of access to primary care, according to Lindsay Dymowski, CEO of Philadelphia-based Centennial Pharmacy Services.

In dentistry, too, greater integration of oral health into the ecosystem would help bridge the gap between it and general health.

“The shift to value-based care, where providers are rewarded for quality care and health outcomes rather than the quantity of care delivered, will incentivize prevention and personalization in care,” said Melissa Burroughs, director of public policy at CareQuest Boston Oral Health Institutes.

The personal relationship between patient and doctor has been largely forgotten as health systems and insurers focus on business concepts like “productivity” and “consumer-driven desires,” and nowhere is this more evident than in primary care failures. argued Dr. Drew Remignanti, MD, a retired emergency room physician and author of The Healing Connection: A Partnership for Your Health.

“Only through a trusting and mutually respectful personal patient-doctor relationship can we safely master the uncertainties of modern healthcare,” he said. “We therefore need to create incentives for primary care for both patients and doctors.”

Social determinants actually determine

In such a dysfunctional system, health inequities are widespread, with about 80% of health outcomes influenced by social determinants of health while only 20% are influenced by actual clinical care, said Didier Choukroun, CEO of SPHERE Investments, a Miami-based company Real Estate Company Real estate company focused on improving the healthcare environment.

Investments must focus on improving socioeconomic factors, the physical environment and health behaviors to promote greater health equity. Such a focus could also be supported by a greater focus on value-based care, Choukroun said.

The reality is that many people with chronic illnesses and low health literacy transition into the Medicare years without the necessary steps to provide appropriate primary care for all from an early age, increasing costs and decreasing the effectiveness of value-based care initiatives. According to Jenn Kerfoot, chief strategy and growth officer at DUOS, a digital health innovator designed to help older people live more independently.

“By ensuring that every American has access to sound health knowledge and preventive care, we can lower costs across the board, reduce the burden of chronic disease and ultimately enable Medicare to better fulfill its mission for future generations,” she said.

Sources say healthcare needs to become more accessible and affordable for patients, while also being more profitable and sustainable for providers. In a country where life expectancy is four years below the average of other nations, the health of the individual must come first, not the health of the bottom line.

“The bottom line is that health care costs in the United States are the highest in the world, and we have little to show for it,” Tien said. “The main reason for this is our reliance on middlemen and the proliferation of bureaucrats, all aimed at making our “system” unnecessarily complex and turning it into a dysfunctional mess.”

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In addition to the United States, the countries surveyed for the report were: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom. Australia was the highest ranked overall system and one of the countries that spent the least on health care.

“Reversing the dismal track record of the U.S. health care system would require numerous, sophisticated interventions by government at all levels and the private sector,” the report concludes.

Nick Thomas is a Denver-based author.