The United States healthcare system is an enormously complex, multi trillion-dollar industry. In the United States, a country without a national healthcare system, the national health expenditure accounts for an astounding 18% of GDP.
But spending lots of money doesn’t guarantee great medical care. In fact, the United States healthcare system routinely ranks lowest when compared to other developed countries.
How is it possible that the United States, the country with the largest economy in the world, does not provide the best healthcare?
Is your loved one getting the healthcare they need? How do you know? And what can you do to make sure your loved one receives the best healthcare possible?
The stress of worrying about a loved one’s healthcare can be overwhelming. The decentralized organization of the United States healthcare system can be intimidating, difficult, and expensive to manage. Use the overview below to gather information so yo can effectively advocate for your loved one. Information is power and it is the key to confidently getting the care your loved one deserves.
Finally, we explain how to not only get healthcare, but how to get GREAT healthcare for your loved one.
Facilities
The United States has a private ownership and competition-based model of provision. This means that the size, location, and cost of healthcare facilities (hospitals, clinics, doctor’s offices, etc.) is determined by the facility’s ability to be profitable. Generally speaking, affluent urban areas are more likely to have high quality medical facilities. Rural and inner-city areas may not have necessary services readily available.
Most hospitals and medical practices are privately owned although some state and local governments fund publicly-owned hospitals and public practices.
Medical technologies like MRIs and CT scanners are used more often in the United States than comparable countries and outpatient services are on the rise. (T. Rice)
The United States healthcare system has the capacity to care for the general population. But location is what makes the difference between an abundance of medical choices or few to none.
Think about the area where your loved one lives. Is there a hospital close by? Doctor’s offices? Maybe they are closest to a clinic or stand-alone emergency room. How many long-term care facilities are available locally? How can you advocate for you loved one so they can use the best facilities available?
Providers
Since healthcare in the United States is mostly private and decentralized, most healthcare providers and practices are also privately owned. Availability of care providers is as with healthcare facilities: More options exist in more affluent locations. Less healthcare providers are available in poorer and rural areas.
Additionally, The Association of American Medical Colleges reports a growing physician shortage due in large part to limited spaces in medical schools and residency programs.
Likewise, the American Hospital Association reports a shortage of nurses. There is a need of 200,000 new nurses per year to meet both increased demand and to replace a significant number of coming retirements (36% of nurses are currently over the age of 50).
As depressing as the shortages sound, reality is that 10% of the United States workforce is in healthcare!
Typically, healthcare providers are certified by accredited private organizations. In the case of many Certified Nursing Assistant (CNA) positions, certification is the end of the process. To be a licensed healthcare professional, such as a nurse, chiropractor, or doctor, rigorous education and training are required to be eligible for certification board approved exam. Once the exam is passed, the healthcare professional is recognized by the state or federal government which grants a license.
For example: Nursing students who have satisfied specific education and clinical training requirements are eligible to take a board certification exam. Each state offers an exam developed by the National Council of State Boards of Nursing. Once the exam is passed, the student may be licensed and has permission to practice nursing in the state where they met the requirements.
Are your loved one’s healthcare providers certified or licensed? Do they hold any specialty licenses? Is their continuing education up to date? Verifying credentials makes sure your loved one is being treated by legally licensed professionals.
Insurance
One can’t discuss healthcare without discussing insurance and funding.
The good news is that over 91% of all Americans are insured.
About 67% of insured Americans have private insurance, the majority of which is through employer-sponsored insurance plans.
Around 35% of Americans are covered by public insurance. Public insurance includes: Medicare, Medicaid, direct-purchase coverage, TRICARE, and Department of Veterans Affairs (VA) or Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) coverage.
So what happens to folks without insurance? They either self-pay (potentially going deeply into debt to do so), receive free care from pro-bono providers, or begin the process of finding insurance through www.healthcare.gov or signing up for a public insurance program after receiving care.
Does your loved one carry health insurance? If so, what kind?
How to Get Great Healthcare for Your Loved One
Do you worry that your loved one won’t get the best care, that they’ll fall through the cracks of the healthcare system and be left defenseless and afraid of the future?
Is the United States healthcare system a giant dumpster fire?
The fact is, the United States is home to some of the most efficient healthcare on the planet. It uses cutting edge technology more than any other developed nation to achieve shorter hospital stays and improve outpatient services. The United States has a large, highly trained workforce of healthcare professionals with more physicians per capita than at any other time in its history.
You CAN get great healthcare for your loved one. The key to success is to educate yourself and your loved one on what is available to them right now. Find out what is missing from their healthcare portfolio and advocate for your loved one to fill any gaps. Understand how the United States healthcare system works and leverage its strengths to work in your loved one’s favor.
Here’s how:
Insurance
- Gather and read ALL of your loved one’s medical insurance policies
- Does your loved one have supplemental insurance? Find that too.
- How about a pharmacy card?
- Put all the paperwork in one place.
- Send your loved one’s Durable Power of Attorney for Healthcare to each insurance agency. This will allow them to legally discuss your loved one’s insurance matters with you.
- Make a list of any questions you still have. Every policy and supplement should have a website and customer support information. Contact the company and get all your questions answered. Email is a great tool because then the responses are in writing to keep for referral later.
Providers: The Medical Team – Physicians / Chiropractors / Physical Therapists /Pharmacists and other Healthcare Professionals
- List all of our loved one’s healthcare providers. If there are several physicians, list them by specialty. Write down names, addresses, and phone numbers.
- Put all the paperwork in one place.
- Who is coordinating your loved one’s healthcare? Oftentimes, it a family doctor or internist. The coordinator should be receiving all of your loved one’s medical records from every health event. For example: Let’s say your loved one’s family doctor is Dr. Patel. When your loved one sees their rheumatologist, the rheumatologist should automatically send an update of your loved one’s medical record to Dr. Patel after each visit. This is how Dr. Patel can monitor your loved one’s progress, compare information with other healthcare events, and make informed suggestions for your loved one’s overall care.
- Send your loved one’s Durable Power of Attorney for Healthcare to each healthcare provider. This will allow providers to legally discuss your loved one’s healthcare matters with you.
Facilities
- Find out what facilities your loved one’s providers have privileges to practice at. For example, not all physicians can see patients at all hospitals. Add this information to your list of providers.
- Note if facilities have an organizational association (such as with a local hospital system) or are an independent facility.
- Follow up after a facility visit to make sure a medical record update was sent to the appropriate member of your loved one’s medical team (usually the coordinator).
True story: My mom was admitted to a large local hospital for treatment after an offsite emergency room visit. My parents assured me that their family doctor would receive an update regarding Mom’s hospital stay. Imagine the family doctor’s surprise (and mine!) when, at a later appointment, we casually mentioned Mom’s hospital stay only to find the records had never been sent. Needless to say, since the medical records were not shared with the family doctor during her hospital stay and he had to make a formal request for the medical records himself.
Conclusion
Worrying about a loved one’s healthcare is a reality for many of us. The overview above will help you lay a strong foundation to understanding the system. Information is the first step to successfully advocate for and getting the care your loved one needs and deserves.
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