High Cost of Medical Care, Not Quality

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High Cost of Medical Care, Not Quality

Laurence T. Gayao, MD


USA spends the most per capita on medical care but is dead last in quality among the ten most advanced nations. Why US have high cost of medical care, not quality?


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President Donald Trump attempt to repeal Obamacare

During the most recent presidential election US President Donald Trump repeatedly said in his campaign, “I will fix the broken US health care system and repeal Obamacare.” Early on in his young administration with the Republican congress, together they tried to introduce legislation to make that change, but failed to do so.  The problem was, they did not have the right diagnosis of what the problem was and they went ahead gave a prescription to fix it. There is no question our healthcare delivery system is broken, but we have to know first what is fundamentally wrong with it in order to make the right changes. They need to go beyond political rhetoric to make the significant changes.


Public health refers to “the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals.”


Medicine “is the science and practice of the diagnosistreatment, and prevention of disease.[1][2] The word “medicine” is derived from Latin medicus, meaning “a physician.” Too often in our present healthcare system the emphasis is more in the diagnosis and treatment and not prevention of diseases.


Public health care initiatives have to a large extent impacted populations’ health in a great way. Vaccinations have almost eliminated many of the common child hood illnesses, we no longer have to deal with polio, smallpox and have prevented influenza pandemics. The in the US we hardly hear of tuberculosis, diphtheria, tetanus and there have been a consistent decline of lung cancer, and cervical cancer as a result of public health measures.


There is no question that medicine in the US is more advanced from a technological aspect compared to most other nations. We have the latest technology to aid health care providers in diagnosis and care of ill patients. This however comes at a significant cost. As a nation US is the highest spender per capita. We spend $8,233 per capita per year and the next closest is Norway that spends $5,388. Averaging all nations US spends 2 ½ times per capita. However in terms of quality of medical care among 10 most advanced nations US is dead last among them.

Key findings related to the U.S. include:

Healthy lives: The U.S. does poorly, ranking last on infant mortality and on deaths that were potentially preventable with timely access to effective health care and second-to-last on healthy life expectancy at age 60.

Access to care: People in the U.S. have the hardest time affording the health care they need. The U.S. ranks last on every measure of cost-related access. More than one-third (37%) of U.S. adults reported forgoing a recommended test, treatment, or follow-up care because of cost.

Health care quality: The U.S ranks in the middleOn two of four measures of quality—effective care and patient-centered care—the U.S. ranks near the top (3rd and 4th of 11 countries, respectively), but it does not perform as well providing safe or coordinated care.

Efficiency: The U.S ranks last, due to low marks on the time and dollars spent dealing with insurance administration, lack of communication among health care providers, and duplicative medical testing. Forty percent of U.S. adults who had visited an emergency room reported they could have been treated by a regular doctor, had one been available. This is more than double the rate of patients in the U.K. (16%).” We have basically a fragmented health system.

“Equity: The U.S. ranks last. About four of 10 (39%) adults with below-average incomes in the U.S. reported a medical problem but did not visit a doctor in the past year because of costs, compared with less than one of 10 in the U.K., Sweden, Canada, and Norway. There were also large discrepancies between the length of time U.S. adults waited for specialist, emergency, and after-hours care compared with higher-income adults.”

“Now that millions more Americans have good coverage, we have to invest in our health care delivery system to be sure all patients—and especially those with the greatest need and whose care is the most costly—can get the high-quality, well-coordinated health care they need,” said Commonwealth Fund President David Blumenthal, M.D. “Those kinds of improvements will go a long way toward improving peoples’ health while making efficient use of our precious health care dollars.”

Use of Computers to Aid in Medical Care

I have have been going to University of Texas Southwestern Medical Center for over eleven years for medical care since I have been treated of thyroid cancer. I have access to my medical records and able to communicate with my providers through their website called My Chart. I could review my test results, appointments, billing information by logging into it. I get email reminders for up and coming appointments.

Many primary physicians have not yet integrated technology in their practices in the care of their patients. In emergency medicine, I have had the privilege of using computerized medical records for over 15 years. It helps physicians have instant access to old records when available, keeps from giving medicines that the patient maybe allergic to or is contraindicated in that patient due his conditions or other medications he is currently taking. It also guide the physician on the proper dosage.

The use of computers could also aids in health maintenance of patients by keeping track of their vaccination status, whether they need colonoscopy, breast cancer screening, pap smear, follow-up on their triglycerides and cholesterol. It also helps keep track of the general patient’s progress. No matter how good the memory of your physician is, he could not remember all these details. Besides, it has been shown that properly used computers may increase the productivity of the healthcare provider. Some of these practice programs subscribe to virtual medical libraries that the physician may access help and the latest information to aid in patient care.

Hope as health care providers and consumers we could help promote the development of a more efficient, comprehensive health care system that blends preventive lifestyle medicine and medical care in the care of patients.

Your Fitness Doc

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