By – Saurav Kasera, Co – Founder at Clirnet
Today’s healthcare system juggles between quality and affordability. With technological improvements and complicated medical conditions, there has been an increase in the overall expenditure for the health systems. This creates a gap between the amount of available and delivered care and what people can afford. For many, especially the underserved, healthcare is still beyond their reach.
What is Causing Rise in Health Expenditure?
Pharmaceutical prices, medical device prices, and the provision of services in healthcare facilities are among the main reasons for the rise in health expenditures. Pharmaceutical companies often emphasize the necessity of price increases to recover their substantial investments in R&D. While advancements in treatment remain crucial, the resulting high prices impact patients significantly, especially in countries where this financial burden contributes to challenges such as overmedication and restricted access to basic healthcare services.
The situation is further complicated by limited transparency in drug pricing and certain monopoly characteristics within the industry. Additionally, companies are often granted exclusive rights to life-saving drugs, allowing them to set prices without always aligning with patients’ financial capacity. As a result, while these treatments may be accessible, affordability remains a significant challenge.
The other major factor contributing to the increasing healthcare expenditures is the fee-for-service payment model. This model incentivises overtreatment leading to the provision of unnecessary services. The result? Meagre results in improved health, which accompanies higher costs and bills for hospital patients.
Solutions to combat rising healthcare expenditure
Adopting a value-based care (VBC) model, which is becoming popular, could resolve such issues. In a VBC system, which differs from the FFS model, healthcare providers are rewarded for the outcomes and quality of the services rendered to the patients. In this model, instead of promoting only revenue generation, providers are encouraged to offer better and customized care without overusing cost-adding procedures. This will, possibly aid to reduce health expenditure in the long run. Value-based care integrates the goals of patients and providers in a manner that thwarts the increases in costs while improving the population’s health status.
The proposition of providing affordable and quality healthcare can be further improved by having more essential primary care centres, particularly in rural and underprivileged areas. This will allow early detection and treatment of controllable disease. Thus, letting is not to spiral out of control to become a chronic or terminal disease that will need expensive treatment.
Primary health care in these geographical areas is complex. It calls for not just more providers but more all-encompassing healthcare infrastructure. Some measures have been taken, such as these mobile clinics and an increase in government expenditure on rural health. Indeed, these initiatives have not been enough to tackle the problem all the way.
Community health centres have been a solution to these issues as they have provided population-level health care, especially to neglected constituencies. These centres are meant to give a particular portion of primary health care services on a schedule of fees depending on a patient’s insolvency. This guarantees that health care is provided even to the poor.
Most of these structures function more than the primary care facility; other services like mental health, dental and even drug abuse treatment is standard. Further, these centres often partner with various specialities and hospitals so patients can get all the required care without overwhelming costs.
There are plenty of reasons why almost all these centres are outposts for preventive care. They have successfully removed barriers to care, improved patients’ health and saved money by preventing and intervening early.
Telemedicine has also emerged as another technique that simultaneously meets issues of access and costs. It resolves those problems by enabling patients who need to see their doctors but do not have the time or financial capabilities to go in person. This is mainly helpful to people with chronic ailments in rural settings or those who have a problem moving around.
Telemedicine ensures prompt consultations, dissemination of information on chronic diseases management of follow-up care while lowering the cost of services. A significant upsurge in the use of telemedicine was observed during the COVID-19 pandemic. It has also shown the service’s potential in the long run. With further technological advancement, telemedicine will bridge the healthcare gap by broadening the scope of services while keeping the costs within reach.
The Power of Preventive Action
Preventive action is a critical feature that should be incorporated to make healthcare available to as many populations as possible. This measure encourages patients to take measures against diseases even before they become chronic, which are very expensive to manage.
People who lead healthy lifestyles, regularly exercise, have proper diet, and avoid substance use will be less prone to diabetes, heart diseases, and even some cancers.
Preventative methods do not only incur initial expenses but also cut down on the costs of treatment of patients over a given prescription period. Coupled with better health for the people, that is an ideal way to cut down health care costs.
It is undeniably tricky to manage the delivery of affordable healthcare services while maintaining a good quality of care. However, the problem is not impossible to solve. Development of a framework by combining sustainable care models such as VBC, telemedicine, and preventative care, will ensure providing affordable and quality healthcare services.
To end, healthcare systems are poised for transformation. However, it is crucial to constantly monitor how these changes will impact the affordability and effectiveness. This will help to make necessary adjustments in the existing models to maintain accessible and high-quality healthcare services for all.
