Every day, we see the impact on the health of the US economy as a result of the shortsighted decisions to outsource America’s manufacturing industry overseas. Now, as a result of a perfect storm of three factors, we are fast approaching the point of having to outsource healthcare as well. These factors are:
1. Shortage of Primary Care Physicians – In a November 2008 American College of Physicians (ACP) white paper, the number of residents entering medical school in the U.S. and selecting Primary Care as a career path has dropped by 50% over the past 10 years. In addition, after five years in Primary Care 21% of doctors switch to a more lucrative specialty. As a result, the ACP predicts a shortage of up to 44,000 Primary Care physicians by 2025.
2. Increase Insured Patients – There are currently 47+Million uninsured people in the U.S. When the final Healthcare Reform legislation is passed, either a public option or a cooperative model will be passed, resulting in more than 50% of these patients adding to the roles of the insured. Add to this the projected population growth over the next 10 years, and the number of insured Americans will rise at least 10%. By 2025, the total US population is expected to rise by 18%. These patients will require healthcare – an even greater burden on an overburdened healthcare system.
3. Explosion of Elderly ‘Boomer’ Patients – Last year, the first Baby Boomer became eligible for Social Security payments. Today, there are an estimated 76 million baby boomers. Older Americans (65 and older) currently make up about 12 percent of the U.S. population. By 2030, once this group retires, the number of Americans aged 65 and older will more than double to 71 million older Americans. Older Americans will constitute roughly 20 percent of the U.S. population. This growth to the senior population will have a devastating impact on the consumption of healthcare services. In 1999, people over the age of 65 years experienced nearly three times as many hospital days per thousand than the general population. This ratio goes up to nearly four times for people over the age of 75.
The ACP paper demonstrates the value of Primary Care physicians in the overall cost of healthcare. An increase of 1 primary care physician per 10,000 population in a state was associated with a rise in that state’s quality rank by more than 10 places and a reduction in overall spending by $684 per Medicare beneficiary. By comparison, an increase of 1 specialist per 10,000 population was estimated to result in a drop in overall quality rank of nearly 9 places and increase overall spending by $526 per Medicare beneficiary. Primary Care physicians reduce the number of emergency room visits and increase preventative medicine. Seems great, right?
If the value of Primary Care is so high, then why do we put such a low financial value on this same care from a reimbursement standpoint? There is no doubt that moving to Pay For Performance and Patient-Centered Medical Home model would go a long way to rationalizing reimbursement based on value created. ‘Home’ refers to continuous, preventative care with expanded hours augmented by nurse practitioners and physician assistants. Instead we pay for procedures, so the more procedures performed, the higher the pay regardless of outcome.
So back to the original premise. At this rate, the bulk of primary care will be outsourced to foreign nationals educated and/or born outside the US. We will take that portion of our healthcare system that generates the most value and outsource it to people who are not Americans. Amazing that we would take a service that is so critical to the fight to reduce our healthcare expenditures and outsource it because it pays so badly in comparison to orthopedic surgery and cardiovascular surgery. What is better – preventing heart disease or conducting bypass surgery after damage is done?
I have nothing against importing labor that is necessary – the information technology industry is replete with examples where this has been valuable. But it strikes me as shortsighted that we have the capacity to train these critical physicians – we just set-up a reimbursement system that discourages it. I’ll discuss the options more but this fall, when you can’t get an appointment with your Primary Care physician as the H1N1 virus rages; remember that your future health will be based on how well we outsource the function and not on our ability as Americans to meet this critical need. This situation is so ridiculous that you would think that changing the reimbursement and medical tort systems would be more important than creating a new insurance mandate. What do you think the priorities of healthcare reform should be?
