What Would You Do to Fix the Failings of Healthcare Delivery ?

[RobbiRN]

Suppose you have the authority to fix the failings of healthcare delivery in the US. Nothing is off limits, and you have the ability to implement change at any level. What would you do?

[student_B, ADN, RN]

Educate the nation on the importance of exercise and healthful eating habits, which would lead to support for taxing added sugars, added salt, saturated fats, and other unhealthy things, and subsidizing healthy foods and ways/means to exercise.

Provide single-payer healthcare for everyone, with incentives to maintain or improve health.

Encourage more healthcare education, i.e., mandatory A&P for all high school students.

Flip the money pyramid so the workers get the lion's share of funding and the executives and advertising departments get the mouse's share.

Make all healthcare not-profit-driven.

[kbrn2002, ADN, RN]

While I get that healthcare in the US is a business, nobody needs to make 7 figures. Stop the crazy high salaries and bonuses those CEO's and other high management receives. Roll that instead into staffing and equipment.

I'm with a previous poster that says do away with insurance altogether. The way the system is currently the insurance companies have most of the power. They are dictating what procedures will be covered, what drugs will be covered and how many ridiculous hoops a policy holder has to jump through just to get anything covered. Reminds me of an old TV commercial for I think some car insurance company ..."what do we do? say NO! how do we do it? Deny the claim!" That ad used to be kind of funny, now it's just too true.

There is not really a nursing shortage in most areas, but there is a provider shortage. Used to be becoming a doctor or a lawyer was the ultimate in "respectable" jobs. Now fewer people are going into medicine. Most likely because the cost of medical school is outrageous, the time commitment is huge and new doctors don't make nearly the lofty salary people think they do. This can be mostly blamed on insurance at all levels. Medicare/medicaid reimbursement is low, what insurance companies pay out for care is low while the bills are sky high. I'd be curious to know the percentage of medical bills that are actually paid compared to the fees that are never recovered. I'd also be curious to know how much of the money that is actually paid out for medical expenses is paid to the providers. I bet it's a pretty small percentage. In the mean time, try making an appointment with a specialist. If you can even make one at all without a referral from your primary provider. Even with a referral some of those specialties are booking out 3 and 4 months in advance.

Last but certainly not least, a complete overhaul of big pharma is in order. First step, stop allowing them to advertise on TV, radio and print every new drug on the market. The correct med for a patient should be determined by the provider with maybe some assist from the pharmacist, not because the patient said to the provider "I saw this ad on tv for so-and-so drug, can I try that?" It'd be different if I believed for a second that the advertising did anything to educate the public about available treatments instead of existing purely to pump up the volume of sales. I truly believe that the massive advertising budget for the new designer drugs are driving the price of all drugs up to what is in some cases ridiculous amounts of money.

[HalfBoiled, BSN, RN]

I would change staffing and eliminate health care insurance. Thus provided it will be replaced with something else.

Also, pharmaceuticals companies cannot make up their prices "because they can."

[skylark, BSN, RN]

The problem with universal healthcare systems is they are abused big time.

ERs are full of non emergencies, who just love the free ambulance rides and the free sandwiches.

The Aus/NZ system is better, where patients pay an affordable fee, something like $25 for an ambulance, and then its refunded IF the ER doc says it was genuine need.

And those whose health is compromised by their lifestyle need to continue to pay. Why should taxpayers pay up for yet another failed detox, or their third asthma exacerbation of the week because they won't stop smoking?

Genuine healthcare should be available for genuine need.

[Simonesays, BSN, RN]

Ohh. This is fun! Bring on the wand!

- universal health care (including dental, vision, mental health care, medications)

- focus on health promotion (i.e. access to affordable nutrition, education related to various facets of health, affordable housing, extended paid maternity/paternity leave, etc etc etc)

- expansion of harm reduction strategies (i.e. safe drug injection sites)

- a cap on the profit pharmaceutical industries can make from medications

- better access to PCPs for patients

- mandatory biannual medication reviews for patients who are taking more than 3 medications routinely by their PCPs in conjunction with a pharmacist (to help prevent interactions, wean off medications when possible, etc)

- improved nurse to patient ratios

- functioning equipment (and enough of it to go around)

- free CEs for medical staff

- improved long-term care for our elderly

- I'm pretty happy with my salary/vacation but would like to see my underpaid colleagues get what they deserve (especially EMTs!)

- Oh! I almost forgot one of the most important ones: bye bye Press Ganey! Cards, thank-you notes- these can be written in lieu of the survey.

[LovingLife123]

I see many people think there should be universal healthcare on here. Do people on here realize exactly how that works? And that the single payer system in the U.K. Is a mess and so many people are unhappy with it? It's not this perfect system. In countries like France, they still have private insurance. People with the private insurance have access to private hospitals. Everybody else with the single payer insurance go to other hospitals and their access to care is not equal. Here, everybody goes to the same hospitals, they all just have different insurance or no insurance. And they all have equal access. People here would scream if thays how it operated here.

[LovingLife123]

If it was up to me, I would overhaul the insurance industry. Insurance companies should not get to make medical decisions. That should be up to the doctor and patient. It really bothers me that Anthem is now deciding after the fact what is deemed an emergency and whether or not they will pay. I see many deaths coming in the future because people are scared anthem wont deem their ER visit an emergency and won't seek help for indigestion that's really a heart attack or a headache that is really an aneurysm. I foresee anthem seeing many lawsuits.

Medicine has become too much about protocols. Nurses should have more autonomy. We should be able to make more decisions in our patients care. I should not need an order for a catheter or IV. Or even an ECG. I should be able to draw labs if I feel something is off on my own without having to call and get an order every time. Too much time is wasted on our parts and the physicians parts with useless orders in a computer.

I would limit medical lawsuits. I would limit what could be sued for and how much could be awarded. Too many frivolous lawsuits cause the cost of all sides of healthcare to go up.

I would change the attitude of healthcare in our society. I would work on preventative medicine and ensure that insurance companies pay for that. They pay for very little preventive care. I talked to my doctor about my weight issues one time. My insurance company refused to pay for that visit. But they will pay for my heart disease and diabetes but not the steps I want to take to prevent it. That's ridiculous. By getting our society more prevantive minded, we can save money in the long term and it would put people in a different mindset. I would also make people understand that you need to pay for your healthcare the same as buying the latest iPhone, or the newest cars. Healthcare is not free. I think by getting our mindset different and thinking about our health differently, we could maybe do that. It wouldn't be easy, but we have to start somewhere.

I would do a major overhaul on our mental health system. This country is in a mental health crisis. Until we fix that, expect drugs and alcohol abuse to flourish. But money has to be spent. By expecting a single payer health care system funded by the government, they will never find mental health. The death toll will continue to rise.

I have many ideas, but this is a small synopsis of what I would do.

[Vtachy1]

The focus should be on palliative, palliative, palliative. There are too many invasive, expensive, medical treatments. Living longer is not always the best. Also, I have a friend, whose husband is on medicaid for healthcare. He visits the ER every other night. It is abuse. I believe that if people want healthcare, then they should pay for it out of their own pocket and not use other people's money.

[wowen]

I would eliminate the observation stay vs inpatient nonsense, I would allow people that have pneumonia get o2 at home, I would eliminate the 3 day in pt qualifying stay for SNF.

[NurseSpeedy, ADN, LPN, RN]

Adequate staffing based on acuity (or just plane time consuming-Johnny you cannot pull out your foley. Mary, you need your IV. Ed, please don't take out your NGT again. You need that because you pulled out your PEG, remember? Jim, no! Do not try to walk out of your bed! You have no legs!. These patients might not be that sick but do not assign them all to the same nurse, please! And say,

Well, you have adequate numbers).

Eliminate HCAHPS surveys for reimbursement. We saved your life. We gave you quality care and informed you what to expect every step of the way. You made poor choices to abuse someone else's prescription medication and take it IV instead of PO. We did not judge you and we gave you medication to help with the pain. We gave you a wound vac to help heal your wound and we gave you iv antibiotics for several weeks for endocarditis and osteomyelitis. The kitchen may not have cooked your burger medium but instead it came out medium well. You may have gotten decaf instead of regular coffee by mistake and I am truely sorry that we ran out of apple juice at 4 am when you drank 2 dozen containers earlier in the shift. For that you will rate us poorly and we will get chastised by management about quality customer service and hourly rounding. The hospital will be reimbursed less because our IVDA didn't like the food. They will be back, with the same problem, and again will be impossible to please. We will save their life again, but it will never mean anything with that stupid survey.

Okay, rant over. Needed to vent.

[kbrn2002, ADN, RN]

If it was up to me, I would overhaul the insurance industry. Insurance companies should not get to make medical decisions. That should be up to the doctor and patient. It really bothers me that Anthem is now deciding after the fact what is deemed an emergency and whether or not they will pay. I see many deaths coming in the future because people are scared anthem wont deem their ER visit an emergency and won't seek help for indigestion that's really a heart attack or a headache that is really an aneurysm. I foresee anthem seeing many lawsuits.

Amen to that. You reminded me of a co-worker that broke her arm. Our insurance company denied the ER claim because she didn't receive pre-authorization. So she was suppose to know before it happened that her arm would break? Or maybe they just expected her to wait to get that broken arm treated until she was given permission by the insurance company to be seen. I do believe she is fighting that, but I never did ask what the outcome was.

[KatieMI, BSN, MSN, RN]

1). Universal health care mandate (plus private commercial insurance available for those who wish to have it).

2). Financial and care-related incentives for preventive care and fines for the lack of it. Smoking tobacco? 1%/year up your tax goes. Hip replacement? Get your diabetes and HTN under control before it happens.

It WILL make waiting times more longer - for some surgeries, quite a bit longer, though.

3). Get direct advertisement of drugs and medical service illegal.

4). Get noveau medications targeting high-risk conditions mandated for coverage. GLP1 agonists like Saxenda have tons of evidence promoting their role in weight loss - they cost a fortune and not covered by most plans, and that's only one example.

5). Drugs prices MUST be federally controlled (and each and every CEO caught price-gauging must see the daylight next time in 10 years or later).

6). Shift action from inpatient to home-based. I believe that this country needs a whole lot of daycare respite centers for aging adults - so that they might stay in their homes and their caregiver could continue with their active lives.

7). Things like yoga, pilates, lightweights, tai chi and Pure Barre should stop be expensive entertaintment for rich and young. Everybody needs them, and everybody should be able to afford them.

8). Allow so-called "mid-levels" to practice within their full scope of practice everywhere in the USA. Get their training under same sort of control as medical schools are.

9). Allow all "mid-levels" and MDs/DOs to be trained in primary pain management, so that they know and do basic things which can solve most pain problems before they become chronic.

10). Eliminate role of HCAPS for reimbursement (and send the authors of this genious idea to court, please).

10 things, just to get started :)