Health Care Crisis in the USA
Original article was published by WHO, World Health Forum Vol. 16, Number 3, 1995 pages 270-271. Readers are encouraged to send their comments on the Editor's Note.
I should like to congratulate Andrew Creese on his article "Global trends in health care reform" which appeared in Volume 15, Number 4 (1).
Optimal utilization of health care resources is a challenge which faces rich and poor countries alike. Health care is a complex mixture of humanitarianism, socialism and commercialism. In the USA, health care is at its finest hour technically, yet it is in chaos on the social and political arena. The USA spends more than any other industrialized country on health care (14% of its gross national product), yet there are still about 44 million Americans who are either uninsured or underinsured. There are plenty of health care resources for everyone's essential medical needs but not enough for everyone's greed and over-utilization.
Our fascination with technology seems to be endless. The development of technology has certainly enhanced our ability to diagnose and treat patients, to the extent that we almost defy death. But this success leads to relentless increases in medical costs. Our concept of health today is a lot different to what it was 50 years ago. Although over-consumption of health resources is mostly blamed on greedy physicians, it is in fact social and medico-legal pressures which are responsible for the over-utilization of diagnostic techniques and various treatments.
I am a practicing obstetrician/gynecologist who faces a daily dilemma of the optimal utilization of fetal monitors, ultrasonic equipment and home uterine monitors. Moreover, the influx of in utero surgical interventions for certain malformations and advances in the field of infertility treatment, if not properly controlled, will start demanding a major portion of health care resources. New high-tech procedures spread like wildfire and sometimes they are embraced long before it is proved that they make any appreciable difference to the outcome. In my teaching experience I have seen residents and medical students dependent on and "addicted" to such technology without a proper understanding of its limitations. I believe that the social pressures behind the over-utilization of resources turn fancy technologies into standards of care before their effectiveness is determined scientifically.
There is no such entity as "free care". The simple economics of the situation is that all treatment is expensive, but inappropriate treatment is the most expensive of all. Managed care and managed competition might save money in the short run, but unless medico-legal crises are dealt with, medical costs will continue to rise. An honest and realistic attitude towards health care is essential. Government regulatory agencies and the volumes of paperwork we have today are far from being the solution: they are part of the problem.
Medicine is not an exact science and perfection cannot be promised. Untoward outcomes are not sometimes beyond human control and are not necessarily the result of the physician's negligence or malpractice. But society has adopted a "Zero Risk" concept which has totally destroyed the art of medicine. The tragic reality is that medico-legal practice is big business. The legal profession had the notion that every unexpected event can be labeled negligence, is preventable, and therefore must be financially compensated.
Patient care is becoming more and more technology-oriented in the USA. The developing countries have done a good job in treating patients with limited technology and clinical medicine. Educational programs, especially in obstetrics and gynecology, such as those established in developing countries with the assistance of the Peace Corps, will not only strengthen the relationship between our countries but might also provide a well-balanced perspective towards health care. Medicine is both an art and a science, and there is no substitute for "hands on" teaching.
Dr. Rita Luthra
Director, Women's Health & Education Center
- Creese, A. Global trends in health care reform, World Health Forum, 1994, 15: 317- 322.
Global Partnership in Women's Health Care is a necessity not a luxury. The Peace Corps is an independent agency within the executive branch of the United States Government. The history of the Peace Corps is the story of tens of thousands of people who have served as volunteers since 1961. Their individual experiences in villages, towns, and cities around the world, have composed a legacy of service that has become part of America's history. Peace Corps' Volunteer Program is associated with United Nations' Volunteer Program. The development of educational programs for the medical students and residents will be an asset, in promoting quality health care (evidence-based medicine) services worldwide.
Dedicated to Women's and Children's Well-being and Health Care Worldwide