The United States pays more for healthcare per capita than any other country, yet our outcomes are less than perfect compared to other developed nations. In an attempt to address the disparity, healthcare professionals are changing how they approach patient treatment.
By the numbers, there is cause for optimism when analyzing healthcare in Utah. When looking at rates of obesity, diabetes, cancer fatalities, complications related to tobacco use and excessive drinking and overall physical activity Utah ranks in the top five, according to a 2017 report from the United Health Foundation.
But we have our problems too. The same report showed we have some of the lowest immunization rates in the country, our mental health coverage is average and our drug-related deaths are on the rise. Our worst performing category, we rank second to last nationally in training and employing primary care physicians. In the long term, this presents a problem for addressing the former issues, especially in low-income populations.
There is a demand on the healthcare industry to provide better patient outcomes while reducing overall costs across the board. Jennifer Dailey-Provost is the executive director of the Utah Academy of Family Physicians. She says an emerging strategy to tackle the challenge is training doctors to focus on preventative medicine to treat health issues before they become expensive, chronic conditions.
“You know, you hear a lot about undiagnosed cancer that’s caught on stage four when it’s extraordinarily expensive and that is definitely a concern," Dailey-Provost said. "And the biggest factor in things like cancer is that the ability to treat them at early stage is astronomically cheaper than, you know, stage four care – unfortunately stage four ends up too often to be end-of-life care. And that’s significant, but the real, true cost, if you’re looking at total cost, is chronic disease. You know, I think 60 to 70 percent of healthcare cost is chronic disease and, like things like cancer, the longer you wait to treat it the more expensive it is. And that’s why prevention is so, so, so important.”
Primary care providers are the frontline for preventative health and if Utah can make up the shortage, addressing the needs of patients and an avenue for cost reduction are opened. Dailey-Provost says the tide is beginning to turn as efficacy of primary care as prevention is proven and insurers become more willing to pay for it.
“Family medicine is the fastest growing specialty in the state by a lot," Dailey-Provost said. "You know, just in the last two years, between 2016 and 2018, we saw our ratio of physicians increase by almost 20 percent. When it comes right down to it, it’s simple economics, it’s supply and demand, and there is a demand and as demand goes up so does the willingness of hospital systems or clinics to pay their physicians better.”
Though change is slow to come and there are hurdles to jump. There are only about thirty primary care residency spots available in Utah which isn’t enough to meet the demand. Also, Dailey-Provost says funding for primary care residencies is provided principally through Centers for Medicare and Medicaid Services, and the stalling of Medicaid expansion in the state over the past few legislative sessions has created problems for low-income patients seeking care.
“If we can finally as a society recognize that, even if you don’t want to look at the moral side of giving people access to healthcare (which I do), it is so much more cost effective to provide comprehensive continuity of care and prevent that heart attack because it keeps people healthy, it keeps them in the workforce, it drives down their cost of care over the long term," Dailey-Provost said. "But until our state policymakers recognize the value of healthcare on the front end and on the preventive end, we’re always going to be having that argument about the cost-benefit analysis of providing poor people with healthcare.”
Dailey-Provost says that unless funding is opened up, patients won’t have the tools necessary to seek preventative care, which feeds into higher overall costs for treating chronic conditions and in turn offers less incentive for primary care providers to offer the preventative care in the first place.
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