Healthcare: Can it be improved? Part 1


Everyone wants to live an active and healthy life and to live as long as possible. The developments in science and new technologies inspire confidence in imminent solutions to the problems of radical prolongation of life, and the prevention and treatment of cancer and cardiovascular diseases. Cell products and gene therapies are already here. They are the present for biomedical science, but still the future for health care.

In developed countries with universal social security coverage, everyone has access to qualified medical care, preventive programs and balanced nutrition. This is not true for developing countries and developed countries with a market health system. 90% of the world’s population lives in such “non-ideal” conditions.
But do the best healthcare systems have no problems?

People turn to doctors. They seek help for a check-up, for advice concerning disease treatment or the prevention of the complications, to discuss their future health perspectives. Medical help should be accessible, timely, effective and safe.

In reality, people face many of the following obstacles:

Information asymmetry

Doctors and patients have different qualifications in matters of health. Patients cannot effectively evaluate and choose a product or service, but must pay for them directly or indirectly. For them the “seller” diagnoses the illness and prescribes treatment, or recommends prevention.

Access to medical records

Patients have limited access to their medical records and often cannot see or correct them. They get instructions on what will be best for them, but do not control important personal information.

Continuity in medical records

In many countries, doctors cannot obtain the medical records of their patients from other hospitals and clinics. Sometimes the continuity of medical information affects the outcomes of treatment.

Length of medical consultations

Attendance time is limited. Patients meet with their doctor for a 10-minute consultation. During this time doctor has to make medical records, make appointments, examine the patient, discusses with them recommendations and possible alternatives, and perhaps reassure patients. It’s difficult to have time to do all this in the few allotted minutes, and most of the time doctors are writing or typing, and patients are waiting.

Queues / Waiting time

Getting an appointment with a doctor can take weeks or even months. The same situation occurs with many diagnostic tests. As a result, a person spends months waiting and during this time does not receive real help. This is not a simple inconvenience. The life quality and expectancy of a person depends on the timeliness of medical care.

Cost

The patient cannot or does not want to wait for “free” medical care or the necessary examinations are not covered by insurance. They have to pay for medical services themselves. In the US, for example, paying bills for treatment is the reason for more than half of all household bankruptcies.

Health professionals’ knowledge and skills

If patients are diagnosed with a serious illness, they “blindly” follow the doctor’s recommendations and do not have a realistic opportunity to check if there is a more effective way. Patients count on the knowledge, skills and expertise of their doctor; on the doctor’s experience and ability to make the best decisions about the latest medical science. But the doctors themselves are in a difficult situation, choosing how to “manage their patients” on the basis of their own qualifications and experience, and, perhaps, the views and opinions of colleagues. A doctor cannot study the hundreds of thousands of new annual publications in their field, even if they limit themselves to secondary sources: Cochrane reviews, meta-analyzes or randomized controlled clinical trials of treatment and prevention methods. Do all the doctors really want to constantly learn, maintain a high professional level and help the patient in the most effective way?

Generalized vs. personalized practices

Patients can receive three types of medical prescriptions. The first ones do not have sufficient evidence of efficacy and safety, and are based on one’s own experience, beliefs and the doctor’s views. In this case, the patient on one occasion receives various recommendations from several doctors. The second ones are proven to be effective and based on the results of high-quality research. This practice is known as “evidence-based medicine”. Preferred practices change and are refined as new information becomes available. The third ones are based on the results of high-quality research, but take particular account of the individual characteristics of the patient. This is “personalized medicine”. The first ones are most common. More useful but less often encountered, sometimes fatefully, are the second or third types.
A patient has to wait for weeks for medical assistance, pay for it, being unsure about the qualifications of the doctor and their access to medical records. Can this be changed and when?
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