The funding for healthcare in the United States is in crisis, but simply putting more resources into the system will not result in the necessary changes which ensure a higher quality of healthcare and health outcomes for Americans. The United States, despite its vast out lay of resources in health, has one of the worst health outcomes in the developed world. While the current healthcare system suffers from a resource problem well described by the economics of supply and demand, the proposed solutions are biased towards supply side theoretical models rather than a systems perspective which seeks to understand the underlying problems and constraints which have contributed to a dysfunctional system which does not meet health objectives and can no longer be sustained.
Physicians, including specialists, exist primarily to provide diagnoses, monitoring and care instructions. Whether it is increased quantity or quality of care which is needed in order to ensure positive patient outcomes, some attention should be paid to the structural aspects of that workforce in terms of the support and implementation of the treatments and care, which do not necessarily require physicians but rather a new kind of healthcare treatment provider. One of the most important aspects of such a role should be in fact prevention of the serious or chronic illnesses which require higher cost care, as anything less makes little sense from the perspective of economics and financial sustainability.
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"Does Physician Shortage = Inferior Healthcare?".
Arguments such as that made by Anderson (2014) at the Heritage Foundation, who believes that expanding access to healthcare will create a dramatic workforce shortage and increased frustration with the healthcare system, seem ludicrous when considered in light of the American healthcare system’s track record. In fact, US healthcare was ranked as the most expensive globally and yet came in “dead last” in a Forbes article which reviewed healthcare in developed countries (Munro, 2014).
In a Huffington Post article Potter (2014) describes how nurse practitioners and other similar professionals are able to prescribe and diagnose much in the same way a doctor can< but the structural need for change goes deeper than this. Healthcare should be about much more than simply a reaction, diagnosis and monitoring of illness, it should be about ensuring the conditions for health, and the preventative interventions and treatments which help to manage problems- and this is not what physicians do. A lack of physicians may not be the problem so much as a lack of a system, structure and roles which ensure our health in the first place. The considerable waste in the healthcare system at the cause of fee-for-service models, failures of coordination, administrative complexity, and failure to implement preventative strategies would free considerable resources which would then be available to the system, but it will not improve health outcomes to allocate those resources to increasing the supply of physicians (Berwick & Hackbarth, 2012). Just as supply side economics focuses on the need for more products for consumption rather than whether increased consumption of goods is what is needed, healthcare solutions have thus far been focused on increasing the resources to provide healthcare, rather than looking critically at why demand is increasing. Another question to be asked is whether increasing this supply will result in value in terms of better health outcomes for Americans. In summary, with regard to whether a physician shortage is equivalent to inferior healthcare, the wrong question is being asked. Americans have had inferior healthcare for too many decades already, and the narrow view that physicians are the core of healthcare is part of the reason that outcomes are so poor. Physicians are needed, but their role is one of many. It is the creative and critical thinkers who can restructure a healthcare system which is functional, easily administrated and results in improved patient outcomes which are in short supply.
- Anderson, A. (2014). The Impact of the Affordable Care Act on the Health Care Workforce. Backgrounder #2887 on Health Care. The Heritage Foundation. Retrieved from: http://www.heritage.org/research/reports/2014/03/the-impact-of-the-affordable-care-act-on-the-health-care-workforce
- Berwick, D. M., & Hackbarth, A. D. (2012). Eliminating waste in US health care. Jama, 307(14), 1513-1516.
- Munro, D. (2014). U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries. Forbes. Retrieved from: http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/#df6e4c11b96f
- Potter, W. (2014). Dire Predictions About Doctor Shortage Post-Obamacare Haven’t Panned Out. Huffington Post. Retrieved from: http://www.huffingtonpost.com/wendell-potter/dire-predictions-about-do_b_5671989.html
