Pay attention to these 5 presidential campaign issues—they could revolutionize healthcare
Key Takeaways
The US healthcare system still has a long way to go in achieving health equity for all, but experts believe that the next administration can accelerate the country’s progress by implementing policies that increase access to (and build trust in) the healthcare system.
Putting preventive care at the forefront, implementing innovative economic models for care delivery, reforming burdensome prior authorizations, addressing disparities in maternal healthcare, and ensuring children have readily available access to care are some of the ways, according to experts, to truly transform US healthcare.
When systems that promote health equity are up and running, doctors can more meaningfully contribute to improving patients’ lives and outcomes.
Only a few population groups enjoy timely access to adequate and high-quality healthcare in the US.[] Too often, as many doctors know, patients do not get the care they need as early as needed. Regrettably, low-income patients, people belonging to racial and ethnic minorities, older adults, and people living in rural communities get the short end of the stick.
Moreover, given that about half of US adults struggle to afford healthcare,[] it’s even more urgent that the next administration take steps to improve health equity and quality care in the country.
With the upcoming race for the US presidential election on top of mind, MDLinx spoke with several doctors and public policy experts about their ideas on how to make this happen.
More funding to preventive healthcare
Though the US has the highest health expenditure per capita among developed and Western countries, only a tiny portion of this money is dedicated to preventive care.[] This is significant, considering about half of all premature deaths in the US are due to behavioral factors and are preventable.[] A mere 8% of Americans participate in routine preventive screenings, which could significantly reduce the risk of diseases that lead to premature deaths, like obesity, cardiovascular issues, and cancer.
With the change in dietary habits from our grandparents’ time to now, there has also been a shift from a more agricultural lifestyle, which involved being active, working the farm, growing vegetables, and raising livestock, explains Kecia Gaither, MD, MPH, FACOG. Dr. Gaither is double board-certified OB/GYN, specializing in maternal fetal medicine, and is the Director of Perinatal Services/Maternal Fetal Medicine at NYC Health+Hospitals/Lincoln.
According to Dr. Gaither, today’s norm is a more sedentary lifestyle filled with foods containing additives, sugars, chemicals, and preservatives. This shift has led to a boom in many morbidities, including obesity, cardiovascular disease, hypertension, cancers, and diabetes.
"More funds should be relegated to preventive healthcare, nutrition education, and screenings for comorbid conditions."
— Kecia Gaither, MD, MPH, FACOG
Sara Gorman, PhD, MPH, author of The Anatomy of Deception: Conspiracy Theories, Distrust, and Public Health in America, backs this up. She asserts that any investment in preventive care, such as better funding for the CDC, signals a commitment to general well-being and often affords people access to better care options.
Revamp economic models for care delivery
“The next administration has to understand that value-based care is not the answer [to improving health equity],” says Zane Gates, MD, co-founder and chairman of Gloria Gates CARE. It is expensive to administer, he says, and if anything, it makes healthcare inequity worse because poor people tend to be unhealthier, and providers get punished for taking care of these folks in their value-based contracts.
The Centers for Medicare and Medicaid Services describes value-based care as “health care designed to focus on the quality of care, provider performance, and the patient experience.”[] Coined by Michael Porter and Elizabeth Teisberg in 2006, it aims to ensure patients get the best care possible while curbing the costs involved, as noted in an issue brief from the Association of American Medical Colleges.[][]
Unfortunately, value-based care models have fallen short of their intended objectives. Expert commentaries and studies point out that they have not reduced care costs or improved patient outcomes. Meanwhile, out-of-pocket healthcare expenses continue to rise at an alarming rate.[]
According to Dr. Gates, the answer to health equity is to build solid and financially stable economic models. This can be achieved through partnerships with health plans to establish capitated payments. (Capitated payments involve paying providers or organizations a fixed sum to cover the expected costs for a patient’s medical care over a set period.)
Address disparities in maternal healthcare
According to the CDC, 80% of the hundreds of pregnancy-related deaths that occur every year in the US are preventable. These are deaths that occur during pregnancy or in the year following childbirth. Black women, in particular, are three times more likely to die from pregnancy-related complications than White women.[] During the COVID-19 pandemic, maternal death rates increased, and so did the racial disparities for Black pregnant women.[]
Dr. Gaither highlights that the primary causes of death for Black pregnant women are hemorrhage, hypertensive disorders, and infection. To address these causes, she suggests implementing programs and policies that provide funding for screenings and support for perinatal social workers and focus on addressing the social determinants of health.
In addition, she recommends the increased implementation of exercise programs and nutritional education, assessment, and supplementation. Vitamin D assessments and supplementation are especially important for Black women.
She also emphasizes that it’s critical that insurance coverage from Medicaid and other health plans extend into the fourth trimester. “The postpartum period is where a high concentration of adverse perinatal events occur,” she explains.
Reform prior authorizations
One promising move in Congress and supported by the AMA that could be expanded on is the proposed legislation to reform prior authorization.[] This, says Dr. Gorman, could afford millions of Americans better and more immediate access to prescription medications.
Prior authorization can be a serious barrier to accessing care and prescription medications. According to the AMA, over 9 in 10 physicians report that prior authorization delays access to necessary care, and more than three in four physicians report that patients abandon treatment due to prior authorization hurdles.[]
Invest in pediatric healthcare
In 2018, the US invested $6,200 in healthcare per child under 19, surpassing every other country’s investment in healthcare worldwide.[] However, this feat is overshadowed by the fact that many children, about 20.3 million, don’t have access to necessary and affordable healthcare.[]
This disparity is reflected in the fact that children in the US have lower life expectancy and poorer health outcomes than children in other developed countries.[]
Dr. Gorman proposes that the government take care of a larger share of children’s healthcare and, just as importantly, invest in school-based health clinics to address the issue of inequitable access to care. “We are one of the only developed nations that expects parents and families to bear so much of the burden of children’s healthcare costs,” she adds.
Given that children spend a significant amount of their time in schools, second only to sleep,[] school-based health clinics play a crucial role in providing accessible and readily available preventive care, physical and mental healthcare, vaccinations, and early diagnosis and treatment.[] Research suggests that these clinics cater well to disadvantaged populations and address barriers to care, improving health equity.[]
What this means for you
The upcoming administration should focus on implementing initiatives to enhance access to and trust in the healthcare system to promote health equity, according to some of today's top physicians. With these systems in place, you can play a more successful role in ensuring that more patients receive high-quality, timely, and adequate healthcare, leading to improved patient outcomes.