Solutions for a Broken Healthcare System

By John W. Peabody, MD, DTM&H, MPhil, PhD, FACP

In the United States, one could easily ask, “If we could make one important fix to our disjointed healthcare system, what would it be?” We could even take the expectation of “one fix” out of the question and instead ask, “What is the first fix?”

The cost of healthcare in the U.S. is remarkably high compared to other industrialized countries. There is no equity in access, and even when care is available, it is too varied. A list of reasons why our healthcare system could be considered broken would go on and on. Activist groups and healthcare professionals alike are calling for change, and while some solutions are being offered, we must develop a starting point if we intend any lasting change to occur.

Arguably, the healthcare system in America began to break when health insurance was introduced into the equation. Health insurance pays for services, not health; this singular focus leads to an isolation of services. The solution to this is to coordinate care. We could accomplish this by encouraging health insurance companies to pay for care integration, or by encouraging pay for health outcomes, not just services.

Technology promotes care coordination

Real, meaningful change begins with metrics and provider support. We cannot be expected to enact lasting change without knowing where the pain points lie; ferreting out those pain points is where good metrics play a role. Many companies have developed means for robust metrics collection. We can now look at averages, costs, patient turnover rates, and profit and loss for individual providers quickly and in one place. With these metrics, providers can make decisions and plans that work toward better health for everyone. Technological innovations and better programs for metrics help support improvements in patient care.

The pandemic brought a lot of change to the world and to the U.S. healthcare system. One of the biggest shifts was the country’s reliance on telehealth. While telehealth existed prior to 2020, the pandemic made it a necessity. Telehealth was a game changer and has opened doors for care coordination.

The road to a healthcare system that runs well for all is a long one, and the United States’ journey is by no means over. Yet supporting providers and creating practical solutions is not as difficult as some may fear. With a concurrent focus on cost, accessibility, and quality, we will soon see improvements, helping to patch the broken system and deliver better outcomes across the board.

John W. Peabody, MD, DTM&H, MPhil, PhD, FACP, is a professor in the departments of Epidemiology and Biostatistics and Medicine at UCSF School of Medicine and a professor in the Department of Health Services at UCLA. He is the founder and president of QURE, a company that engages providers, improves the quality of clinical care, lowers costs, and supports care transformation.