This is an excellent article, although it's limited by the demands of bevity. There is a lot more that could, and should be said on the subject. The United States spends twice as much as any other developed nation on health care, but still has millions of people uninsured, and ranks behind the other nations in measures of infant mortality, life expectancy and healthy life span. The problem is that the money goes, not to care, but to the administrative costs of processing bills, and the efforts to control costs are focused, not on cutting administrative costs, but reducing the costs of direct care. The result is that those involved in care have to increase productivity in order to meet expenses. Physicians have to see more patients in order to compensate for lower reimbursements. Typically, the efficient medical office will not offer test results over the phone, but will only discuss them at a subsequent visit. This increases the number of visits, but reduces the time allocated to each contact.
There is a similar pattern in pharmacies, where the need for productivity reduces or even eliminates pharmacist-patient contact. In order to keep costs down, technicians take in, fill, and even do the actual dispensing. The pharmacist, who should be speaking to the patient, reviewing use of over-the-counter medications, discussing the proper way to take medications, is reduced to checking the technicians' work against the prescription.
This unfortunate state is worsened by the cost efficient desire to keep low inventories in order to maximize return on investment. Low pharmacy inventories mean more prescriptions are short-filled. Again, the staff work-load is increased by the need to fill the balance of the prescription, and the patient has to make a second trip to the pharmacy in order to pick up the balance of the medication.
While no single factor can account for the total failure to take medication properly, the cumulative effect is to take a system where, in theory, the patient is a full paerticipant in care, and produce depersonalization and indifference. The factor of understanding, the critical link between taking a pill and improvement in a medical condition, is never completed.
There are a number of possible approaches to this problem, but the annoying reality is that every attempt at resolution will either increase costs for the third party payers, or reduce income for the providers. It would seem that the state of health care in the United States has gotten bad enough so that we should be anxious for a significant improvement, but of the presidential candidates, only Representative Kucinich offered a meaningful resolution. A single-payer plan, for example, would cut administrative costs, freeing up funds for higher professional fees which would allow more time to be spent in counseling. Senator Edwards offered a half-measure, with the understanding that his proposal could be converted to a National Health Service when the nation was ready (Senator Clinton has adopted the Edwards proposal, implying that she too feels the United States doesn't yet have the will to support a true single payer plan.) The Republican candidates have generally opposed anything relating to socialized medicine or "European Socialized Medicine. We can hardly expect the providers to assume the additional costs of providing adequate counseling services, nor will the third-party payers increase their fees in order to cover these services. (Note -- even if fees were increased, there's no assurance that physicians and pharmacists would use the higher fees to provide improved services. It might be essential to interpose yet another layer, a patient educator -- and there are drawbacks to this too. There really are no easy answers.)
It's one thing to recognize a problem, another to agree on a solution, and so far, as a nation, we haven't even taken the essential first step. Until we do, things will only get worse.
