In the secondary application or during an interview, medical school applicants may be prompted to comment on the current state of the health care system in the U.S. The question can be posed in different ways. Schools may ask prospective med students to provide their views on health care reform, offer their assessment of the U.S. health care system or propose solutions that could improve medical care at a population level.
To answer all of these questions, it is helpful to have a basic understanding of the key challenges affecting the U.S. health care system. There may be some disagreement, even among experts, about which issues pose the greatest challenge. However, most would agree that the U.S. can make improvements in several areas. Here are four key challenges:
— U.S. health care is expensive.
— Higher prices do not translate to better health.
— Wide disparities in health care exist in the U.S.
— Primary care needs to be made more robust.
U.S. Health Care Is Expensive
Compared to other high-income countries, the U.S. spends substantially more of its gross domestic product, commonly known as GDP, on health care. In 2017, the U.S. spent over 17% of its GDP on health care, a considerably greater proportion than most other high-income countries. To put this in perspective, France spent 11.3%, the United Kingdom spent about 9.6% and Italy spent about 8.8%, according to the World Bank Country Health Expenditure database.
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Recent analyses have revealed why health care costs may be higher in the United States. Part of it can be explained by the fact that people in America pay more for medicine than other developed countries. Expenditures per capita on drugs in the U.S. were $1,443 in 2016, while all other countries included in these analyses were at less than $1,000 per capita, ranging from $466 to $939. Also, the U.S. health care system spends substantially more on the administrative costs of health care.
Another contributing factor is that Americans order more tests such as MRIs and CT scans than people in other countries. Experts believe that one influential factor in the U.S. is the practice of “defensive medicine.” This refers to the idea that physicians may — out of an abundance of caution — order unnecessary diagnostic tests to leave no stone unturned and avoid possible lawsuits.
Simply put, health care in America is more expensive than in other industrialized countries, and since health care is a finite resource, the higher the price tag, the less there is to go around.
Higher Prices Do Not Translate to Better Health
Even though the U.S. typically spends more on health care than other high-income countries, we achieve poorer health outcomes in many areas, according to data from the Organisation for Economic Co-operation and Development, or OECD. For example, we had the lowest life expectancy in 2017 among 11 high-income countries including New Zealand, Sweden, the United Kingdom and Germany. In Switzerland, average life expectancy was 83.6 years compared to 78.6 years in the U.S.
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Other key metrics of health are also more favorable in high-income countries that spend less. The burden of chronic diseases is higher in the U.S. than virtually all other high-income countries. In the United Kingdom, France, Switzerland, the Netherlands and Germany, 18% of adults or less report having two or more chronic conditions like diabetes and high blood pressure. In the U.S., the figure is nearly 30%.
Wide Disparities in Health Care Exist in the U.S.
One of the greatest health care challenges in the U.S. is the wide gap in the level and quality of care between different segments of the population. This means that certain communities suffer higher rates of disease or disability, have poorer survival rates for various diseases and live shorter lives. Some factors that may influence health include race, ethnicity, socioeconomic status, gender and sexual orientation.
In some areas, improvements have been made in recent years. For example, although health insurance coverage has traditionally been low among people of color, the Affordable Care Act led to expanded coverage by increasing the number of people eligible for Medicaid. As a result, the gap has been narrowed, but disparities remain.
Progress is still needed in other areas, according to data from the Kaiser Family Foundation. Infant mortality rates among Black communities is more than twice that of white communities while the death rate for Black people with an HIV diagnosis is more than seven times greater. In a similar vein, Black, Native American and Hispanic populations have higher rates of diabetes.
These disparities have come to the forefront recently with respect to COVID-19, the novel coronavirus. New reports point to substantially higher infection rates among Latino and Black populations compared to white people. Similarly, COVID-related mortality rates among African Americans and Latinos are higher than for white people.
Primary Care Needs to Be More Robust
Not all Americans have a primary care provider, or PCP, who they see regularly, and the percentage who see a PCP appears to be declining, according to a research report last year in JAMA Internal Medicine. PCPs play a number of key roles in health care, one of which is to promote health and prevent the onset or complications of disease.
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A patient who regularly sees a PCP is more likely to get disease screening and receive an early diagnosis for chronic conditions like diabetes and high blood pressure. A PCP can help a patient with chronic conditions to better manage those conditions, which reduces the likelihood of complications such as cardiovascular disease.
Part of the problem is a shortage of primary care providers. Unfortunately, among graduating medical students, there is less appeal for primary care specialties like family medicine. Primary care physicians have lower salaries than their specialist counterparts. This — and the prestige associated with going into specialty fields — may deter medical students from pursuing primary care.
As future physicians look ahead, there is a lot of work to be done to improve the U.S. health care system. Medical schools are interested in applicants who show an awareness of and interest in these topics.
This information is meant to give premed students a broad framework for understanding some of the areas where challenges exist. We encourage students to build on this knowledge by reading current events related to health care in the news. Medical journals like The New England Journal of Medicine and the Journal of the American Medical Association also provide insightful articles on issues related to health policy.
As you read up on these issues and increase your knowledge base, it is important to recognize that this is a vast field and no one expects you to fully understand every topic. Instead, try to gain a broad understanding and develop opinions on key issues that affect health care.
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U.S. Health Care System Challenges: What Every Premed Student Should Know originally appeared on usnews.com
