Is expensive healthcare worth the wait?

Expensive healthcare

The United States healthcare system is the most expensive and overall worst among developed countries, but at least it’s faster, right? As it turns out, the long waits that plague the Department of Veteran Affairs are nothing but the proverbial tip of the iceberg. In fact, the VA at least has the redeeming quality of being one of the only healthcare systems in the U.S. that openly tracks and has standards for waiting times, similarly to the national systems of Canada and Great Britain, two countries whose waiting lists have been negatively compared to those of America.

                However, a study by the Commonwealth Fund concluded that 26% out of 2,002 American adults polled had to wait six days or more for medical appointments, only slightly better than Canada and Norway and worse than the Netherlands and Britain. According to Commonwealth researcher Robin Osborne “it’s the primary care where we’re really behind,” in particular non-emergency appointments such as heart checkups, visits for knee pain and routine gynecologic exams. Moreover, physician staffing firm Merritt Hawkins conducted a survey of 5 types of doctors’ offices in 15 metropolitan areas to determine how many days on average patients wait to see a specialist.

Average wait in days per area/specialty

 

Dermatology

Ob/Gyn

Family practice

Cardiology

Orthopedic surgery

Boston

72

46

66

27

16

Minneapolis

56

10

10

15

5

Philadelphia

49

22

21

6

5

Denver

37

22

16

28

15

Seattle

32

10

23

9

6

Portland, OR

27

35

13

12

10

New York

24

10

26

15

9

Detroit

22

16

16

17

18

Houston

21

14

19

11

5

Dallas-Ft Worth

17

10

5

11

8

Washington

17

15

14

32

11

Miami

16

13

12

18

9

Atlanta

14

15

24

11

6

Los Angeles

14

8

20

12

7

San Diego

14

14

7

28

18

 

The cumulative average wait time for all specialties in all 15 metropolitan areas is 18.5 days, including Saturday and Sunday. Seems a bit long especially taking into account the $2.7 trillion that that U.S. healthcare system costs -$8,508 per capita or 17.7% of the gross domestic product, whichever you prefer. But there is a correlation between expenditure and wait times. Simply put it goes like this: profitable procedures get done fast regardless of how perfunctory they may be; on the other hand, office-based medical appointments that are not lucrative to doctors or hospitals get pushed way down to the back of the line.

For example, knee replacements, MRIs, or Botox injections are scheduled in a few days, asthma patients with worsening breathing, diabetes patients who need a medication adjustment, or elderly patients with chest pain which requires a cardiology consultation find themselves in the position of the inmates at the Berghof sanatorium, whose smallest unit of time was the month. This why systems like England’s National Health Service (NHS) tracks how many patients wait more than six weeks for needed diagnostic tests and also stipulates that patients should wait no more than four hours in an ER if they are to be admitted to a hospital. They know that time is money. What’s more, it’s not just a public health issue in the UK, but a political one as well. In other words, heads would roll like they have at the VA.

Healthcare economist at Northeastern University in Boston Dr. Steven D. Pizer has said that shorter wait times in the U.S. could be within reach if nurses and physician assistants were allowed to open their own practices and perform simple diagnoses and procedures. Patients can also contribute by delaying or desisting from expensive elective care in order to make room for patients who more urgently need primary care, such as “the old and frail who have conditions that require frequent monitoring,” as former White House Fellow with the Veterans Affairs Department and professor at NYU Langone Medical Center Dr. Dave A. Chokshi puts it.