When a certain restaurant opened in Chicago a couple of years ago, it garnered a ton of buzz, press and high expectations. It would feature a seasonal menu, each with a creative and extremely specific theme, such as "France in 1883." Food would be presented to you in an interactive way. Oh, and you would not be able to make reservations. Instead, you would need to buy a ticket online — the cost of all the food and beverages you select, plus a 20 percent service charge — and show up within 15 minutes of your allotted time, or run the risk of losing your table. All ticket sales were final.
The restaurant said that, unlike an a la carte restaurant with many walk-in customers and dozens of menu items, it was creating "a truly unique dining experience" and "doing so at an amazing price." The tickets, it reasoned, eliminated no-shows, required prepayment and varied in price by time and day "to offer a great deal more than would otherwise be possible at these prices."
It all seems a bit too haughty to me, so I've never made an effort to buy a ticket. But I must say, the restaurant has established its rationale for this system. Its narrow access — that takes a considerable amount of planning on the diner's part — is in exchange for a high-end experience at an "amazing price."
That tradeoff is hard to find in healthcare. Instead, it looks something more like this: Narrow access — that also takes a considerable amount of planning on the patient's part — in exchange for an unpredictable experience at some of the highest prices in the world.
It wasn't much of a surprise when the Commonwealth Fund released a study last week that showed American healthcare spending rocketing beyond that of 10 other Western democracies. The United States spends $8,508 per person on healthcare — about $3,000 more per person than the second-highest spender, Norway. Plus, about 41 percent of insured and uninsured U.S. respondents spent $1,000 or more out-of-pocket throughout the year on medical care, not counting premiums. The next country to even come close to that was Australia, where 25 percent of respondents did the same.
What was interesting, though, was the lack of correlation between American healthcare expenses and access to providers. Healthcare access in this country resembles a scam, particularly in light of what we spend and when compared to healthcare systems around the world.
The U.S. came in dead-last out of the 11 countries surveyed for after-hours primary care: Only 35 percent of adults' primary care physician practices have arrangements for patients to see physicians or nurses after hours. (In the Netherlands and the United Kingdom, this figure is 95 percent.) The U.S. came in third-to-last when it came to physicians' response time to patients who call with a question — 73 percent of U.S. adults said they "always or often hear back on the same day," while 90 percent said the same in Germany.
This is what the research says, but it's quite easy to pick up on this trend anecdotally, as well. At the Becker's CEO Roundtable last week, a speaker told a story about how someone he knew grew very frustrated with his medical care. This man's physician told him to make a follow-up appointment for six weeks later. When he called to book the appointment at said time, an administrative assistant told him the best they could do was an appointment two months later. "Well, the doctor told me to come in six weeks from now," the patient said. The administrative assistant's response? "Well, that's what he said. This is what we can do."
Long wait times for physician appointments make up a huge problem, but it's a complex one not easily solved by one party. What healthcare providers can fix, though, is their attitude about this. The lack of apology and consolation in that employee's response is absurd, as is the suggestion that a physician's recommended timeframe for an appointment is secondary to the front desk's booking outlook. Patients aren't exactly being high maintenance when they want to abide by the schedule their physicians set for follow-up care. Front desk personnel may want to stop treating them as such.
There are plenty of problems to ponder and discuss in healthcare, but access to care is one that seems downplayed among hospital and health system leaders. A few executives at the roundtable event did mention their partnerships with federally qualified health centers, to match patients in their ERs with primary care physicians if they do not have one, and the development of after-hour clinics. It's my hope these initiatives are being executed much more regularly than they come up in conversation, maybe because they are not as risky or interesting to discuss as say, accountable care organizations or launching a health plan. Sometimes the talk doesn't match the pace of the walk, and I'm hoping that's the case here.
If not, I think another speaker said something quite interesting at the roundtable, and I'll leave you with his words. Michael Sachs, chairman of Skokie, Ill.-based Sg2, brought the conversation back to what the patient sees. "You walk in, you need care — do you really check to see whether the physician is employed or independent? I don't really care what the organizational structure is," he said. "I think what we need to be doing is thinking about how to create the best patient experience."