US Healthcare Problems

The United States is home to some of the best and worst care. The US Healthcare Problems list is the product of GoInvo’s efforts to understand why these gaps exist and how they impact us. By drawing attention to the most prominent problems faced in our healthcare system, we can start to envision how it may be redesigned.

GoInvo has spent the last two months researching and breaking down these problems. The result is a list ranked based on several quantitative indicators, such as number of deaths, number of American people impacted, dollars spent or lost, and number of related problems. The interconnected nature of the US healthcare system makes it extremely challenging to separate these problems. We have coupled analytical skills and interest in health policy to bring to light this complex web of menacing realities. Unsurprisingly, all problems can be attributed to the fee-for-service system in some way.

We encourage you to be appalled by these statistics... and then do something about it.

Rally your friends (virtually), pick a problem, and dive in. Use the "What's being done" column in Airtable to evaluate current efforts and potentially join them. Copy over our Airtable and continue researching, adding metrics, and brainstorming solutions. Create an interesting data viz. However you choose to get started, this is an opportunity to understand healthcare's complexity and contribute to the efforts of improvement.

1We pay a lot for a little1, 2

The United States spends more on healthcare in terms of %GDP than any other country — yet has the lowest life expectancy, highest suicide rates, highest chronic disease burden and highest obesity rate out of all countries in the OECD (Organisation for Economic Co-operation and Development).

328M People Impacted - $3.8T Spending

2COVID-19 continues to kill3, 4, 5, 6, 7

471K lives have been lost, 1.7T US government dollars have been spent, $3-4T in US GDP is projected to be lost over the next 2 years, and the US unemployment rate is almost double what it was in 2019, with one-third of the total unemployed now categorized as long-term.

552K Deaths - 328M People Impacted - $1.7T Spending

3Death is premature8, 9

900,000 people die each year due to the top 5 leading causes of death: heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries. Several deaths are driven by health disparities defined by social, economic, and environmental disadvantages. However, 20-40% of these deaths can be avoided by changes in personal behavior, such as eating healthy, exercising, and stopping smoking.

900K Deaths - 360K People Impacted -

4Errors are 4th leading cause of death10, 11, 12

Behind heart disease, cancer, and COVID-19. These errors include patient misdiagnosis, incorrect prescription of a drug or procedure, and hospital based infections. Most people will be subject to at least one diagnostic error during their lifetime. These errors often go unreported.

250K Deaths - 328M People Impacted - $750B Spending

5Spending is wasted13, 14

25% of healthcare spending is wasted on failure of care delivery, failure of care coordination, over-treatment or low-value care, pricing failure, fraud and abuse, and administrative complexity.

328M People Impacted - $935B Spending

6Prices vary11, 15

Based on your insurance plan and health care facility, the price of an intervention can vary by as much as 65%. This is because the rate for every service is negotiated between payers and providers. Medicare prices are closest to the actual costs of care.

328M People Impacted - $235B Spending

7Preventive care is prevented11, 13

This leads to both health and economic impact. When preventive care is not prioritized, patients get sicker, end up having to pay more for their care, and in a lot of cases, die. Economic productivity decreases when patients need to take time off of work to address preventable illness.

328M People Impacted - $260B Spending

8Prices are unknown11, 15, 16

Most patients and physicians don't know the price of the care they are receiving or delivering. Healthcare is the only market where buyers pay for services they don't know the price of, and receive a surprise bill weeks later.

328M People Impacted - $507B Spending

9Physicians are administrators11, 16, 17, 18

They spend more time with EHRs than with their patients. The average physician visit is about 8 minutes long. Administrative tasks, such as computer data entry and negotiating with insurance companies, take time away from physicians doing their actual job - providing care.

328M People Impacted - $266B Spending

10Suicide is 10th leading cause of death8

In 2018 there were 48,000 deaths due to suicide, with 1.4 million attempts. When a person dies by suicide, the loss is felt by many, causing ripple effects of grief and trauma.

48K Deaths - 328M People Impacted -

11Physicians are financial decision makers11

The cost of care is typically unknown to physicians who are taught to order whatever they believe the patient needs regardless of the price tag.

328M People Impacted -

12Patient data is not all in one place18, 19, 20

Although over 90% of care facilities have adopted EHRs, data still fails to be standardized across systems. This makes it difficult for physicians to have a holistic view of patient health and for patients to move their care to other facilities. Lack of standardization may result in duplicate services which are a major source of unnecessary costs.

328M People Impacted - $30B Spending

13Anonymized data doesn't always stay that way64, 65

Research has shown how cross referencing from multiple datasets (anonymized and non-anonymized) can lead to identifying the individual that the data belongs to. This can lead to very obvious security concerns.

328M People Impacted -

14Coverage is unknown

Deductibles, co-pays, co-insurance, out-of-pocket limits, out-of-network care are all just fancy words for 'I really have no clue what my insurance covers'.

298M People Impacted -

16Our medical data is for sale65

Very few healthcare professionals and patients know that the health data that they enter into the EHR or relates directly to them may be de-identified and sold over and over again to companies that use that data for various purposes: identifying untapped markets, tracking drug usage, etc.

328M People Impacted -

17Our medical data is used against us64

Health care companies or insurers may purchase customer data that helps them raise product prices for specific demographics.

328M People Impacted -

18Insurance doesn't mean coverage11, 23

The Americans who are covered by employer-provided or government health insurance are still under-insured. This means that their insurance doesn’t adequately cover the costs of health care for them, and they incur several out of pocket expenses. Employers picking the right insurance plan for their employees requires an understanding of the complex offerings and anticipation of healthcare needs for the coming year. This is extremely challenging to do, even for experts in the healthcare field.

298M People Impacted -

19Patients don't own and control their data24, 72

Patients don't have direct insight into how their provider is managing their care. This can lead to healthcare paternalism, where providers make care decisions that they believe are in the best interest of the patient, and the patient has little to no transparency on their entire health picture. This also means that data lives within the healthcare system rather than with the people who created it in the first place. New Hampshire is the only state where patients have been given ownership of their health data. Most states don't have any explicit laws outlining who owns health data.

328M People Impacted -

20Data breaches are frequent25

With the increase in digitization of healthcare data, ranging from credit card details to patient diagnoses, data breaches are frequent.

328M People Impacted - $6.2B Spending

21Smoking is still prevalent26

Tobacco use is the leading cause of preventable disease, disability, and death in the United States. 40 million US adults smoke cigarettes, and 4.7 million middle and high school students use at least one tobacco product, including e-cigarettes. Nearly half a million Americans die prematurely each year due to smoking or secondhand smoke. 16 million live with a serious illness caused by smoking. The United States spends nearly $170 billion each year to treat smoking-related disease in adults.

500K Deaths - 44.7M People Impacted - $170B Spending

22Healthcare is tied to employment27, 28, 29

The US is the only country where healthcare is tied so closely to employment. Approximately 49% of Americans receive coverage through their employer, leading to issues such as job lock, inequity, and fragmentation of healthcare finance. This system was heavily implemented during the labor shortage and wage freeze in World War II to attract employees. It's remained the same ever since.

156M People Impacted - $260B Spending

23Anxiety and depression is up59

During the pandemic, about 40% of adults in the U.S. have reported symptoms of anxiety or depressive disorder, up from 10% of adults who reported these symptoms from January to June 2019. Adults are also reporting negative impacts on their mental health and well-being, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%).

84M People Impacted -

24High costs delay treatment30, 31, 32

Almost 25% of Americans delay or stop medical treatment due to the associated high costs. In many cases, this leads to death.

45K Deaths - 82M People Impacted -

25People are lonely67, 68

Loneliness and social isolation continue to be prominent challenges especially in a world where we are prescribed to socially distance ourselves from others. People experiencing these health impacts may be at higher risk of serious medical conditions such as dementia.

127.5M People Impacted -

26Eating habits are poor33

42.4% of U.S. adults have obesity. Obesity-related conditions include some of the leading causes of preventable death, including heart disease, stroke, type 2 diabetes and certain types of cancer. The medical costs for people who have obesity were approximately $1,429 higher than those of normal weight in 2008.

88M People Impacted - $147B Spending

27Patients pay more for coverage than employers34, 35

Higher deductibles are raising the share that patients pay for their own care. This means lower monthly payments with an increased risk of large medical bills you can't afford for emergency care. High deductibles work fine for those who are generally healthy, but are unattractive to those in poorer health. Doctor office visits and preventive care screenings have seen reductions as patients pay more for care directly out of their own pocket.

156M People Impacted -

28Mental health is not treated as health11, 36, 37

20% of Americans don't receive required mental health services. Often they can't afford it or don't know how to seek help because it's treated completely separately from physical health. The most serious cases are seen among adults who are uninsured and living in poverty.

48K Deaths - 66M People Impacted - $225B Spending

29Patients lie66

Up to 81% of patients lie to their doctors in order to avoid judgment. These lies can have significant implications for patient health, especially if they have a chronic illness.

169M People Impacted -

30Prescription drugs are unaffordable23, 38, 39

Half of the population regularly takes prescription drugs, 25% of which struggle to afford them. With drug patents driving a lack of competition in the pharmaceutical market, companies raise the prices of drugs arbitrarily.

40M People Impacted - $335B Spending

31Adults aren't getting a good night's sleep40, 41

One third of US adults report that they get less than the recommended amount of sleep (7 hours per 24-hour period). Not getting enough sleep may lead to many chronic diseases and conditions and can lead to motor vehicle crashes and mistakes at work, which contribute to injury and disability each year. Individuals who sleep fewer than six hours a night on average have a 13 per cent higher mortality risk than people who sleep at least seven hours. $411 billion in GDP is lost each year due to lack of sleep.

70M People Impacted - $411B Spending

32Patients don't understand their health42, 43

Personal health literacy, as defined by Healthy People 2030, is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Adults with low health literacy experience 4 times higher health costs, 6% more hospital visits, and 2-day longer hospital stays.

118M People Impacted - $226B Spending

33Sicker patients pay more11, 44

The poorer you are, the more you may delay seeking care. The later you seek care, the sicker you get. The sicker you get, the more services you may require. The more services you require, the more you pay. The base rate of hospitalization is multiplied by several factors that are meant to reflect how difficult it was to care for the patient.

40M People Impacted -

34Alcohol is misused45

An estimated 95,000 people die from alcohol-related causes annually. In 2010, alcohol misuse cost the United States $249.0 billion, with three-quarters related to binge drinking. Approximately 14.1 million adults and 400,000 youth have alcohol use disorder (AUD).

95K Deaths - 14.5M People Impacted - $249B Spending

35Higher paying jobs lead to better coverage28

26% of Americans receive employee sponsored health insurance with no tax benefit at all because their income is too low. Only one-third of workers in the lowest fifth of the wage distribution are offered health benefits and less than 20 percent of them accept those offers. In contrast, more than 80 percent of workers in the top fifth of the wage distribution are offered health benefits and accept them.

85M People Impacted -

36Physicians are emotionally exhausted46, 47

Physician burnout is characterized by emotional exhaustion, depersonalization, and a sense of reduced accomplishment in day-to-day work. There is a strong relationship between burnout and errors, where burnout leads to errors and more errors exacerbate burnout. A physician suffering from burnout is less productive and likely to quit practicing, driving up costs associated with recruiting a new physician.

120K Deaths - 420K People Impacted - $4.6B Spending

3780% of medical bills contain errors62

As many as 80 percent of hospital bills contain errors, leading to overcharging up to thousands of dollars for services. Doctors and admin must sift through thousands of diagnosis and procedure codes for billing.

$210B Spending

38We've overdosed on overdose deaths48

Over 81,000 drug overdose deaths were recorded in the 12 months ending in May 2020, the highest number ever recorded in a 12-month period. These numbers suggest an acceleration of overdose deaths during the pandemic.

81K Deaths -

39Poorer patients are sicker30, 44, 49, 50

Residents in the poorest neighborhoods are in worse health and live 10 years shorter than those in the most affluent areas. This is due to inequitable access to healthcare facilities and insurance.

40M People Impacted -

40Food access crisis is worsening51, 52

The number of Americans facing limited or uncertain access to sufficient, nutritious food for a healthy life have skyrocketed due to COVID-19. Food insecurity disproportionately affects low-income Americans and communities of color who are already at higher risk for preventable chronic diseases and negative health and economic outcomes associated with COVID-19.

54M People Impacted -

4130 million are uninsured23, 31, 53

74% of the 30 million don't have health insurance because they can't afford it. Uninsured adults have worse health outcomes, higher rates of mortality and premature death, inadequate access to preventive services, and expensive medical bills.

45K Deaths - 30M People Impacted -

42Racial disparities exist63

People of color and low-income individuals have faced barriers to accessing care, including insurance, compared to Whites and those at higher incomes. Heart disease mortality rates among Blacks and diabetes mortality rates among American Indians and Alaska Natives have increased over time. These disparities are costly.

$135B Spending

43Physicians over-treat to increase revenue11, 14

The fee-for-service system rewards action instead of health outcomes. Physicians over-treat patients to increase their bottom line.

$101B Spending

44Hospitals are used as primary care providers60, 61

Declining number of patients have a primary care provider that isn't the emergency room.

9M People Impacted -

45Rural patients are sicker10, 54

Rural patients lack convenient access to healthcare facilities and comprehensive insurance coverage. If medical services are covered, the coverage is insufficient. These factors contribute to serious health problems in rural areas.

60M People Impacted -

46Physicians engage in fraud10, 14, 55

This includes billing for services not provided, falsifying credentials, billing for duplicate services, and recommending services where they hold financial incentive.

$68B Spending

47Sicker patients aren't employable56

The chronically ill face challenges finding and maintaining a job that can support their expenses. For this reason, they are likely to wind up in poverty.

40M People Impacted -

48Physicians care defensively11, 57, 58

Defensive spending includes over-testing and over-treating patients, as well as avoiding high-risk patients in order to decrease risk of malpractice law suits.

$50B Spending

49Physicians are closing up practice70, 71

Several doctors are planning on leaving the medical profession or retiring earlier due to the pandemic.

120K People Impacted -

50Healthcare is a dangerous profession69

Private-sector healthcare workers in settings such as the hospital experience workplace violence-related injuries at a rate 5 times higher than the rate for private-sector workers overall. The most common types of reported assaults were hitting, kicking, and beating.

15M People Impacted -

We'd Like Your Feedback

We’ve highlighted the top problems related to healthcare in the US. We’d like to acknowledge that some of the problems you may expect are not present; this may be due to ongoing research by our team or inconclusive data. Racial inequities in healthcare and medical bill errors are two prominent issues that are at the top of our radar. Where data is available, we’ve listed quantitative metrics supporting the severity of each problem. We encourage you to explore the list and references, and send your feedback on this draft to hello@goinvo.com.

Licensed under Creative Commons Attribution 4.0 license.

About GoInvo

GoInvo is a healthcare design company that crafts innovative digital and physical solutions. Our deep expertise in Health IT, Genomics, and Open Source health has delivered results for the National Institute of Health, Walgreens, Mount Sinai and Partners Healthcare.

Methodology

v3 - 1.Apr.2021

The list has been expanded to include the top 50 US healthcare problems. We have started linking resources to organizations that are tackling these problems, and are exploring an API integration for Airtable so the list automatically updates as we make changes.

v2 - 17.Feb.2021

The list has been expanded to include the top 40 US healthcare problems. We have updated the ranking algorithm to consider a weighted average of each of the quantitative metrics.

=0.25*(deaths/max(deaths))+0.25*(spending/max(spending))+0.25*(peopleimpacted/max(peopleimpacted))+0.25*(relatedprobs/max(relatedprobs))

The equal (0.25) weighting may be adjusted over time with supporting literature.

Stay tuned for V03 where we will include a visual representation of the connectedness of these problems, and showcase the current status of each problem being addressed.

v1 - 11.Feb.2021

The US Healthcare Problems list began as a google spreadsheet research effort, with sources including “The Long Fix” by Vivian Lee, CDC, and CMS. Our team aimed to pool relevant quantitative and anecdotal information for each outlined problem, making it possible to start to prioritize what needs addressing. Ideally, the move away from a fee-for-service system and towards a value-based approach would alleviate some of this burden.

Fee-for-service: payment is dependent on the quantity of care

Value-based: payment is dependent on the quality of care

The initial ranking is based on the quantitative data as well as the prevalence of the problem as explained in research.

Authors

Hannah Sennik, GoInvo

Hannah Sennik drives a rare trio of skills: bioengineering, systems design, and art. With a BASc of Systems Design Engineering from Waterloo, she joined Apple Computer to calibrate, instrument, and test hardware services. A MSE in BioEngineering Design from Johns Hopkins University pushes Hannah’s goal of melting design, healthcare, and system engineering into her wetware.

Juhan Sonin, GoInvo, MIT

Juhan Sonin leads GoInvo with expertise in healthcare design and system engineering. He’s spent time at Apple, the National Center for Supercomputing Applications (NCSA), and MITRE. His work has been recognized by the New York Times, BBC, and National Public Radio (NPR) and published in The Journal of Participatory Medicine and The Lancet. He currently lectures on design and engineering at MIT.

Eric Benoit, GoInvo

Eric Benoit is the Creative Director of GoInvo, leading the studio’s UX creation process from concept to production. Eric works as an interaction designer, experience designer, and information architect, designing better products by thoroughly understanding user behaviors, expectations, and goals. Eric’s background and love for design in the context of human experience helps him transform complex information systems in healthcare and the enterprise into responsive and adaptive human-centered designs.

Additional Contributors

Brad Dumke
Megan Janas
Susan Woods, MD

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References

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