Columnist Dr. Cheryl Christy

Author's note: This column is intended for educational purposes only. It aims to highlight gaps in health knowledge, provide support and empower organizations to guide their members in creating effective health and wellness programs.

The U.S. health care system is a high-cost, fragmented hybrid model (public and private) without universal coverage. It is primarily employer-based, with rising premiums and out-of-pocket costs. Despite high spending — $4.9 trillion/$14,570 per person and 18% of GDP — this system produces a lower life expectancy than other high-income nations. Health care spending is a function of utilization and price. Several factors affect spending, such as an aging population, new innovative technologies, waste in insurance and provider payment systems and hospital consolidations.

HOW IT BEGAN

Sometime in the 18th century, health care evolved from unregulated, home-based medical care provided by physicians with informal medical education to a complex, evidence-based, scientifically and technologically driven system in the 21st century. While physicians provided health care to the wealthy at home, nurses cared for the poor inside hospitals. Following the Crimean War, Florence Nightingale revolutionized hospital care by enforcing strict standards of sanitation and hygiene, implementing data-driven analysis and creating the first nurse training program. Her use of statistics proved the connection between poor sanitary conditions and high mortality rates. The 19th century saw many archaic medical practices become obsolete thanks to the push toward scientific rigor, which led to advances in antibiotics, vaccines and surgical procedures.

Another major turning point came during and after World War II. Wage controls made it harder for employers to compete by raising salaries, so health benefits became a way to attract workers. Over time, health insurance became tied to employment, a defining feature of the U.S. health care system.

Modern medicine has become incredibly effective at treating acute care needs, emergencies and surgically driven problems. But it is structurally weak in addressing the root drivers of disease that alternative therapies have been addressing. This includes nutritionists, chiropractors, physical therapists, holistic providers, health and wellness specialists and health literacy advocates. Although they are not rejected by the medical community, the commitment to building a healthy mind and body feels secondary to the pressing needs of acute care. We became a “sick” care society rather than a health and wellness society. While solving one problem, others were created.

1. The rise of evidence-based medicine

This was meant to protect patients by requiring treatments to be backed by evidence-based research. But research favors what can be measured, patented and scaled. Medications, tests and procedures fit that model perfectly. Nutrition, lifestyle counseling, family medical history and health literacy are more difficult to code for reimbursement and are not as profitable to treat.

2. Pharmaceutical dominance

Medications became the fastest, most efficient intervention within a system under pressure to find answers. Meds are scalable, billable and protocol-driven, and have become the default treatment. Patients complain of being on “too many medications for too long without a change in health.”

3. Time compression in clinical practice

The average primary care visit is now around 10-15 minutes. During that time, writing a prescription or referral, or ordering tests, is feasible, but addressing the root cause of a disease is time-intensive.

4. Reimbursement structures

Insurance pays for procedures and prescriptions more readily than for health coaching, preventive and wellness counseling or alternative therapies. Clinicians are pulled toward what can be coded and reimbursable.

5. Employer-provided insurance

This offered millions of working families coverage, but it also created a source of instability — lose your job, and you lose your insurance unless you can afford temporary COBRA coverage. It also meant coverage grew unevenly, favoring people in stable, full-time work over those in part-time, low-wage, seasonal or informal jobs.

ENDING ON A POSITIVE NOTE

The U.S. health care system has genuine strengths as a home to world-class trauma care, specialized surgery, biomedical research, transplant medicine and advanced diagnostics. Care can be extraordinary for those who are well-insured, live near strong institutions and can navigate the health care system.

Dr. Cheryl Christy is a Baldwin County resident and registered nurse with nearly 30 years of experience. She holds master's degrees in nursing education and nursing practice and a doctorate in nursing practice. She is a member of Sigma Theta Tau, Phi Pi Chapter, a certified lay counselor and the author of "Voices for Healthcare," a health care blog.

Read her previous column titled "Voices for Healthcare - Disconnecting from health" on www.GulfCoastMedia.com.