Amit Paranjape’s Blog

Issues With America’s HealthCare System – A Patient’s Perspective

Posted in Current Affairs, Healthcare & Medicine by Amit Paranjape on April 14, 2009

I had the misfortune of suffering from an extended illness in America and experienced firsthand the many problems and issues with the American HealthCare system. In this brief article, I will try to list some of the major ones that I can recollect from my personal experience (See list below – points are in no particular order).


Please note that I still believe that the American HealthCare system is amongst the best in the world; especially when it comes to treating really tough medical conditions, and performing complicated surgical procedures and emergency medical services. It still retains some of the best doctors and other medical talent in the world.


My issues are more systemic and process related. In the end, one would expect a little more from world’s most advanced and expensive healthcare industry! Note these are my personal observations – whether some of these points can be generalized further needs more data points from other patients and consumers of this healthcare system.


1. Cost of HealthCare Insurance – The cost of healthcare has undergone a major increase over the last decade. The increasing insurance premiums have forced many private sector companies (that offer health insurance to their employees) to increasingly pass on a bigger chunk of these costs to the employee. This increase has been significantly more than the rate of inflation, and has resulted in no perceptible change in the service quality.


2. High costs for the un-insured, and the under-insured – This issue is extremely critical and has already been discussed ad nauseum in every media outlet, by numerous experts.


3. Insurance Claims Processing – Even for patients that have some of the best insurance coverage, the process of settling claims is far from perfect. Discrepancies and errors are common. In certain cases, interpretation of ‘what’s covered vs. what’s not’ is not clear. The 3-way communication across, Doctor’s Office – Insurance Company – Patient, further adds to the process complexity and mismatches. I personally had to deal with many of these claims related issues. To resolve these, often times you end up spending hours on the phone with the insurance company.


4. Impact of ‘medico-legal issues related complications’ on behavior? – I am not a legal expert and cannot pass explicit judgments here, but sometimes one gets a feeling that the entire medical staff’s (not just the Doctors, but also the Nurses and other support personnel) interactions with a patient are biased by a ‘medico-legal’ angle. Most answers are very generic, vague and filled with ‘disclaimers’. I understand that this is a big issue, but it is a bad trend if it affects the medical staff and patient communication. This communication channel needs to be one of those most ‘open’ ones!


5. Accessibility of a doctor – Most doctors work during the regular office hours and are not available on evenings and weekends. Hence seeing a doctor often times results in a forced half-day vacation during weekdays for many patients. Evenings and weekends are out of bounds and if you are in urgent need to see a doctor, in most cases an Emergency Room is your only option.


6. Difficulty in getting to a specialist – Often times it’s very difficult to schedule an appointment with a specialist. Many are booked out weeks into the future. And if you can’t see them right away, and are in some serious trouble, the standard answer that you might get is ‘Go to an Emergency Room!’


7. Difficulty in asking any simple follow-up questions to a doctor – If you have the most mundane follow-up question, it is still very difficult to directly ask your doctor. Even if you call during office hours, your call is routed to a nurse who often has no background about your particular case (except for some case-papers). Typically, the nurse is very busy and answers a simple – ‘I will get back to you’. If you call outside office hours, then your best bet is an answering service! I agree that many times it is not feasible for a busy doctor to directly talk to the patient. But some intermediate solution needs to be worked out. After all, I think that the most expensive healthcare system in the world should have at least some ‘personal touch’.


8. Information Technology in Healthcare – I get the impression that the Healthcare industry hasn’t leveraged IT to the fullest extent as compared to many other industry sectors. This can be seen in hospitals as well as in doctor clinics. From basic things like Electronic Medical Records (also referred to as Electronic Health Records), to a better integrated hospital management system (across billing, insurance, clinics and service providers) a lot of improvement is needed. Even today, there’s hardly any electronic data interchange of a patients reports, health records and doctor’s notes across practices and hospitals.


I have had to fill in volumes of paperwork every time I went to see a new doctor. Why can’t there be some automation of a patient’s insurance records and medical history? Why does a new patient have to arrive at a new doctor ’15 min early’ to fill out reams of paperwork, many times when he is not in a mental/physical condition to be dealing with this? A patient has to maintain an increasingly heavier load of files, and paper documents, and make it accessible to any new doctor that he might be seeing.


9. Difficulty in Scheduling Simple Procedures – Even simple diagnostic procedures (e.g. Ultra-Sound, Endscopy, etc.) can sometimes take days or even weeks to schedule. I don’t really know why this happens. Is this merely a scheduling problem or a supply scarcity of resources?


10. Newer patented drugs are regularly being introduced and are prescribed in many cases. Not sure if the incremental benefit that some of these provide over the existing older (and still under patent) or off patent/generic drugs can be weighed against their exorbitant costs. I am not an expert and cannot make this judgment, but do think that this is something that needs to be researched further. Again – since the US consumer is supposedly the ‘richest in the world’ he has to pay the highest (in most cases) for the patented drugs compared to other developed countries. This is another issue that has been a big point of contention, with lot of discussions in the media.


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8 Responses

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  1. Shashi said, on April 14, 2009 at 2:03 pm

    Michael Moore’s documentary “Sicko” covers some of the major issues written by you. Though I don’t take everything from his film on its face value, it still is worth a watch.

    So, how does it compare with India?

  2. Sam said, on April 14, 2009 at 4:18 pm

    Comparing with India?! I think the best part is that so far india does not have a “system” in place 🙂 But the biggest benefit here seems to be the “personal touch”. Its also surprising to hear that the information systems are not in place still in US!

    Off course apart from all the issues mentioned by Amit, the healthcare benefits do indeed work fine there for probably less complex cases. There are many happy patients!

  3. Prasanna said, on April 14, 2009 at 8:39 pm

    Being a doctor is not a “noble” profession as it used to be – at least in US. Majority of the doctors look at their work as simply a job and/or a business and don’t take the time to help heal the patient. Hence the insistence that they work only in “normal” workday hours. Instead, if doctors start becoming flexible to accomodate patients then at least some of the root causes related to scheduling can be addressed. Also, the litigative nature of the society has contributed to the evolution of the state of health industry today in US.

  4. Pradyumna said, on April 14, 2009 at 10:44 pm

    There is no comparison between India and US to be made, unless we specify which part of the population we are speaking about. I think that standards for medical care and more importantly access to it accross America dont vary vastly with geography, economic background, race, religion. In India sometimes we extrapolate the experience of a few, at the top of the economic pyramid to represent the entire pyramid. That makes the comparisons of all sorts a risky affair.

  5. Anup said, on April 15, 2009 at 8:54 am

    What’s missing in the US health care system is Adam Smith’s invisible hand. The health care system is not driven by the free economic principles, but is controlled by regulatory agencies and giant insurance companies that are maximizing their revenues. Manipulation of supply (with things like in-network, out of network coverage) causes a mismatch with the demand patterns. Increased legal risk for doctors, and processing costs drives up the cost for the consumer. The uninsured and illegal immigrants misuse the free ER services and drive up the cost for the rest of the population.
    The best solution I have heard to date is to let each individual choose their own insurance coverage, much like car insurance. That would increase competition and reduce prices while improving service levels… interestingly the car doesn’t have to wait to get treated if it gets into an accident. As for the occupants, they are at the mercy of the insurance companies!

  6. Amit Paranjape said, on April 15, 2009 at 10:18 pm

    All, Thanks for all your comments.

    Anup – Agree with your reasoning to some extent. There are high barriers(time and money) for anyone to become a Doctor in America, and many difficulties for a foreign-born Doctor to easily practice here.

    Hence I think we don’t have a perfect market. The supply is too constraint, and demand is ever increasing.


  7. santosh harakamani said, on May 31, 2009 at 10:09 pm

    I had to undergo an unfortunate interaction with the US health care system. Being in emergency centre I had to wait for Doctor (health centre) verify with Insurance company whether I had significant coverage for the treatment needed and later prolonged fight with insurance for certain claims. Here Doctor’s (health centres) are bound by Insurance terms than moral medical practice.

    But my concern was not about what exists in US then but reading a lot about big plans of Global insurance companies plans for India and their might I had feared one thing, that this trend would emerge in India. We in India never had the insurance culture as the access to health care was and is available.

    Now I live in India and I see my fears coming true 
    If you look carefully the emergence of insurance companies and our dependency on them and slowly the increasing cost to access health care. So what is changing?
    Is it the cost of increased value of life?(like in developed country) or our ailments are severed? or the better and newer technology and facilities?

    The best health care system I have seen is in Sweden that has a history of being Socialist system having very strong social system. All tax payers come under government health insurance accepted across state of the art commun (municipality) medical centre and regional medical centres that have world class facilities. But then we are under heavy tax regime that is cost  but we don’t need to be under the mercy of private insurance companies and not sure you get covered for what you have paid.

  8. Amit Paranjape said, on June 1, 2009 at 3:33 pm


    Thanks for your detailed feedback. Guess you had similar experiences as mine.

    Regarding Swedish system being better, I don’t have any first hand experience with the European system – but have heard many similar points of feedback. The issue/debate there though is that of tax-payer subsidizing the entire healthcare system. Oh, well..but then that’s a topic of a separate blog article I guess!


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