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U.S. health care: Are we getting the bang for our buck?

P.K. Jain
Tuesday, Apr 2, 2013

Spending $2.7 trillion on health care, this accounts for approximately 17 percent of the U.S. GDP, or national spending. For a country that spends the most money on health care in the world, one would expect the U.S. to be among the leaders in not only innovation but also quality of care and positive health outcomes. However, this is not in the case - in reality the U.S. ranks 50th in terms of life expectancy (CNN). This appalling statistic raises alarm and should make us question if we are really getting the bang for our buck?

It is next to impossible at this point to deliver the best care possible with our health care system being so fragmented and broken. Essentially, the fee for service structure of our health care system has fostered an unrealistic approach to deliver quality care to patients, who do not receive the best deal on their end. The pricing structure and competitive delivery structure of health care has transformed the system into a profit driven business. It all boils down to quantity and not quality at this point, taking the focus away from what really matters - the best interest of the patient. At the end of the day, physicians are expected to reach a certain volume of patients to cover the exorbitant costs of practicing medicine in this country, which often jeopardizes patient quality care in the process and leads to less comprehensive care. But who is to blame for this? As a society, we must take the blame away from the providers, and look it as a problem within the system.

Currently, our health care system has turned into a money-making machine for certain stakeholders, primarily insurance and pharmaceutical companies. This infiltration of lobbying within the healthcare system has resulted in a healthcare system dictated by who has the most competitive approach with the most money on Capitol Hill. Physicians and patients are merely pawns caught in the middle of this chess game, forced to play the game without even being able to have an adequate strategy. Thus, decision-making for health care policy needs to focus on a more patient-centric approach, rather than benefiting stakeholders who often have their own agenda and schemes for making a profit. This current trend within the health care industry is not sustainable and has resulted in a major dissatisfaction among not only the providers, but also the patients leading to poorer health outcomes. Thus, the importance of having appropriate regulatory and policy framework in place is now realized.

The focus needs to be more on quality rather than just fee for service, where prevention and wellness promotion are encompassed with delivering the best quality care to patients. Thus, as U.S. health care reform is now focusing on preventive and wellness measures, they are looking more toward the primary care sector to have a more active role in overall care for patients. Increased screening and physical and preventative exams are being heavily emphasized because the goal is to catch problems early before these diseases occur and become more costly to manage. Many of the chronic diseases such as diabetes, COPD, hypertension that are so widely prevalent in our community and all across the nation can be avoided by lifestyle changes. However, the demands within the primary care sector as being gatekeepers for health care has essentially fostered expectations that go beyond what our healthcare system equipped for. While the primary care level is being held accountable for meeting these quality measures and is expected to achieve better health outcomes, they are not given the proper tools and resources to feasibly implement these changes, thus are not to blame.

Consequently, the infrastructure and implementation of an efficient cost-effective system proves to be a major challenge and requires major change to properly function. Ultimately, our U.S. health care system is set up for failure without making the necessary changes to increase the level of health care we deliver in a more cost effective and efficient manner that results in better health outcomes. Hope should not be lost and there is light at of the end tunnel, but not met without uncertainties. Thus, to get the bang for our buck, we need to take the initiative ourselves and treat our body like temples. While there is still a long way to go to fix the problems within our health care, the key recommendation to the Upper Cumberland is to stay optimistic and better our community through healthy lifestyle choices. This will allow for patients to get the most of their health care and get the best bang for their buck.

P.K. Jain, M.D., is CEO, president and medical director of Cookeville Medical Center PC, located at 225 N. Willow Ave., Cookeville, and its affiliated entities, 402 E. Gore St., Gainesboro. For more information, call (931) 528-8899, (931) 268-6899 or visit or

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