Fragmented Nature of U.S. Health Industry
In the past, when an individual was acting abnormally in a way that caused reasonable suspicion from their neighbors, holes were then drilled into that person’s skull . . . quite frankly, in the most painful way possible. This trepanning process served as a ritual to let out evil spirits within. Needless to say, most of these patients did not survive the next day to tell surgeons if it worked — ha, it’d be a Christmas miracle if they did.
However, in comparison to the complicated healthcare world we exist in, some would argue that these patients were, in fact, actually lucky to escape our health system. No wait times, no tricky scheduling, no paperwork, no debt, and best of all: everything was free!
Of course, this set-up was not the best version of healthcare by any means, but nobody can argue the fact that it was way simpler than the one we have now.
Healthcare was not always this complicated. Its level of complexity has increased considerably with the rise of capitalism, technological advances, and modernization. About 200 years ago, healthcare used to be primarily contained within hospital walls, where treating, billing, and other processes took place. Be that as it may, modern hospitals are only a small part of the grand scheme.
Today, healthcare consists of hospitals, clinics, physician offices, pharmaceutical companies, insurance companies, and many more entities. In that respect, the distribution of power these previously mentioned institutions have on healthcare contains great disparities, as some have more influence than others. And breaking down the different participants will allow us to better understand the true power dynamics within the system.
Theoretically, to function smoothly as a singular system, all entities must work together in constant coordination and communication with each other, but does this theoretical situation hold up in reality?
Alain C. Enthoven, assistant secretary of defense for systems analysis, who studies integrated delivery systems, claimed, “Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources.”(footnote) He put forth the argument in many of his published works that healthcare today lacks the integration and unity needed to provide the highest quality care and performance achievable for patients.
His arguments hold a great deal of insight when we take a closer look at the dispersed nature of the health system. As mentioned earlier, healthcare was originally confined to hospitals, but our increasingly specialized professions and modern healthcare now require patients to travel great distances between the different institutions to receive holistic care.
As we can all vouch for — to some degree — our local hospitals, primary care physician offices, pharmaceutical pick-up clinics, insurance companies, dentist and optometrist offices, and homes are not within walking distance of each other. Not to mention the added processes of scheduling the appointment, driving to the location, and paying for the services. To make matters even more complicated, each of these entities has different financial incentives, billing procedures, systematic processes, and allotment of resources, making it difficult for them to coordinate with each other.
These are only some of the problems that system fragmentation poses for the quality of healthcare for patients. Enthoven’s assertion does not acknowledge other closely related problems, such as the high variability in costs and information asymmetry for patients who were not specialized in the medical field.
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Enjoyed this article? Over the next weeks, I’m going to be sharing excerpts from my book in this article series. The Healthcare Conversation: Navigating the U.S. Health System is available now on Amazon in both paperback and ebook format. If you want to read more stories like this, please check it out and let me know what you think! To connect, you can reach me here via email at linhdoanvo@gmail.com or on social media at linhnout on Instagram.
