The Challenges of Population Health Management
The United States has the most advanced health care in the world. There are gleaming medical centers across the country where doctors cure cancers, transplant organs and bring people back from near death.
But a poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health shows that only one-third of Americans say the health care they receive is “excellent.” Even fewer people are impressed with the system as a whole.
“When you’re talking about health care, we have this amazing kind of schizophrenia about our system,” says Dr. Georges Benjamin, executive director of the American Public Health Association.
The split in thinking shows up in the poll numbers.
Much the way people hate Congress but love their own representatives, people like the care they receive while complaining about the system. About 80 percent say they get good or excellent care. But 42 percent rate the health care system in their state as fair or poor.
You can find the detailed results of the national poll here and results on how income affects health care here.
Results for the individual states:
“We deliver the best medicine and nursing on the planet, no question about it. But it requires a lot of things,” Benjamin says.
Things like an insurance card, filling out lots of forms, paying copays and deductibles, and running from doctor to lab to imaging center.
The system is wildly complex and hard to navigate, and can be very frustrating. Benjamin says it’s this process of getting health care that people hate.
Just ask Cheryl Vaun, one of our poll respondents.
The 57-year-old from Albany, Ore., has a low opinion of the health care system after spending years trying to help her daughter who fell suddenly ill as a teenager.
The 16-year-old gained 30 pounds in about a month. She had migraines and her muscles would seize up in pain.
Vaun and her daughter went from doctor to doctor repeating the same tests and procedures. When doctors couldn’t figure out what was wrong, they offered Vaun’s daughter antidepressants.
“We were pretty upset,” she says. “My daughter was devastated because obviously she’s suffering all of these health issues and it was a bit terrifying.”
Vaun’s daughter was finally diagnosed with acute anemia.
If the problem had been caught earlier, Vaun believes her daughter could have recovered. Instead it has become a chronic condition that leaves her tired and weak. The treatment is iron pills or injections, which are hard on her system and leave her sick to her stomach.
Repeat tests, multiple doctor visits and lack of results erode people’s faith in their care, says Sarah Dash, vice president for health policy at the Alliance for Health Reform in Washington, D.C.
“Health care hasn’t always been designed with the needs and efficiency of the patient in mind,” Dash says. “It’s designed for the various doctors and the health care system.”
The poll, conducted from September to November, also shows that quality of care can depend heavily on a patient’s income.
Adults with incomes below $25,000 a year are about three times as likely as higher income people — 34 percent versus 13 percent — to say the health care they personally receive is only fair or poor.
William Dale Coger, 52, is one of them. The carpenter from Oak Hill, W.Va., says he’s been unable to get help for his back, which he injured about 15 years ago while hauling pipe out of a well on his property.
His pain, mild at first, has gotten worse over the years. These days, he struggles to get out of bed in the morning and finds his left leg is unstable and his left foot goes numb.
“It’s gotten to the point that this pain travels clear up my back into my shoulder blade into my left side of my neck and gives me migraine headaches sometimes into the left side of my head,” Coger says.
He’s on disability and Medicaid.
Coger sees doctors at a local clinic, but he says they don’t take his back trouble seriously. They recommend exercise and offer ibuprofen. He thinks surgery would be able to help him but says doctors at the clinic refuse to order an MRI.
“I want to be cured,” he says. “I don’t want pills. I don’t like pills.”
Benjamin of the APHA says Coger and his doctors don’t seem to have the same goal. They’re managing his pain; he wants to get back to work.
“It can be really frustrating if you don’t understand the end goal of your care,” Benjamin says.
Dash says the Affordable Care Act includes lots of pilot projects to improve how patients get care — and to make it cheaper. But those changes come slowly in a system that today is wildly complex.
And for most people, the law seems to have changed little.
The NPR poll shows 74 percent of people believe their health care has stayed about the same since the ACA was implemented. And for the minority who’ve seen a change, about 14 percent say their care is better while 9 percent say it’s worse.
And most think the law has had no direct impact on them.
Even if they didn’t buy a plan through the exchange, people have more insurance benefits than they did before. They get free screenings like mammograms and colonoscopies. Birth control is free. And they can still buy insurance even if they have a pre-existing medical condition.
Most people aren’t aware of that, though. Our poll shows only 1 in 6 adults think their benefits have increased in the past two years, and 12 percent believe they’ve declined.
And many people still don’t like the law.
Ivan Rivera, 29, from Miami, says he is opposed to Obamacare and is angry that he’s required to get insurance.
He says he works hard, takes care of his own health and doesn’t want to have to subsidize coverage for others.
“We’re paying for other people,” he says. “People that are not working. People who are not pulling their own weight.”