Underprivileged has fewer options- even with the Nordic Healthcare System!

15 min read

Photo by Tom Parsons on Unsplash

We all discern that everyone deserves “Quality Healthcare.” Besides, there is no argument; we all needed it yesterday, and- not merely tomorrow. We likewise have our own percept as to what that quality care is supposed to mean. The concluding notions don’t necessarily divide us as to what needs to be done to achieve affordable, high-quality medical service. Instead, what truly rubbles society is the impracticable conception of logistics around healthcare deliverance.

There is an overwhelming controversy as to what is an excellent solution.

Amid all the confusion, one ideology that is most prevalent in our system is the subject of the “National Healthcare system” or generically speaking, the rhetoric of a government-run single-payer arrangement. In fact, the overwhelming population of the United States feels in the metaphoric sense, Grass is seemingly greener on the Other Side of the Fence!

Every nation confronts its own unprecedented hurdles when it comes to healthcare. The major disputes on the theme are converged on three main aspects of Quality, Universality, and Affordability of the medical services. Even Though the prospects hardly see the likelihoods.

Our societies are sustaining a universal dilemma. In our sphere, every individual has the liberty to choose a healthy lifestyle founded on personal knowledge and accessible sources. That is why the United States serves as the most comprehensive consumer-driven market epitome; still, many contend that healthcare doesn’t fall under such a business model.

Hypocrisy turns out to be more apparent when the global officialdoms such as the World Health Organization (WHO), advocate for personalized Healthcare System. But Personalized scheme can’t be resourcefully executed beneath the Bureaucratic universal healthcare archetype. The national health system by nature would inevitably lead to scarcer options and ascended costs. Something, which the concluding is inimical to what genuinely personalized healthcare stands for. More so, it will merely ensure least and defective coverage, which not only wouldn’t actually cover everything but demands higher taxation.

Millennial Expects more, Convenient and Better

But Universal care can’t provide it all! — As a matter of fact, with regards to personalized attention, and the exquisite expectation of the millennial, universal healthcare coverage is a short falling triumph. The clash of the modern attitude of the Younger generations with that of the traditional government labored healthcare reimbursement system has created notable displeasure with how they are experiencing medical care. Hence, According to a survey, only 55 % and 67% of the millennial and generation X respectively have an elected primary care physician.

The young age is more likely to try alternative conventions for receiving medical care that is spacious and affordable. Nonetheless, the government’s efforts have failed to fulfill market requirements. Physicians also are grudgingly preoccupied with complying with inside information of the mistaken resolutions, while non-clinical entities are privileged taking over the medical panorama.

Photo by Roman Kraft on Unsplash

Healthcare Problem is Multifaceted

One of the significant issues with the current attitude is the failure to recognize healthcare problems. The ordinary citizen hopes to find a mature resolution, but within the process, he or she forgets to focus on the ABCs. For instance, according to a most recent report from NPR In Hamburg, Germany, the approximate life expectancy in the city’s more underprivileged districts is way below that of wealthier neighborhoods. The difference is as vast as 13 years in age.

Germany prides itself on possessing a competitive healthcare system, widespread insurance coverage for everyone, the abundance of primary care service, affordable medication costs, and the least out-of-pocket expenses for citizens. The countries success closely parallels its economic feat. Nevertheless, managing the healthcare demands of low-income patients still seems to be a big problem. Similarly, U.K. Hospitals are overwhelmed with the patient demands, Although the British pride themselves of their National Health System (NHS) too.

To direct the Healthcare dilemma German system has designated locations with front patient rooms and large meeting areas in the rear typically located in busy shopping centers. The said facilities don’t necessarily have onsite physician staff. Instead, they are operated by other workgroups called “health counselors.”

Photo by Tom Parsons on Unsplash
Photo by Tom Parsons on Unsplash

The counselor’s duties in the German system are to offer guidance on healthy living and leadership on how people with chronic health conditions should care for themselves. The health counselors serve as the communicants between patients and physicians as necessary.

The strategy utilized by German healthcare officials is not a new one. Using non-physician workforces to overcome poor physician force distribution while addressing common challenges has been already advocated and instituted by two Chinese mentors, literacy advocates, and organizers, Y.C. James Yen and Liang Shuming in 1920. It seems to me that their concept serves as the modern era of primary care medicine.

It takes a village to take care of a patient

Yen and Shuming’s philosophy ( also referred to as Barefoot doctor’s theory) enabled a group of rice farmers, to deliver healthcare to rural neighborhoods where urban doctors would not toil. The barefoot doctors aided and facilitated essential hygiene, preventive healthcare, and family planning to the underserved farming communities.

But medical care is only part of the healthcare problem equation, as an array of determinants of health play a significant role in defining what a given community needs at a certain point in time. Some of those determinants comprise those of big-picture social items like affordability, quality nutrition, and safe exercise zones. Or they may entail small ones, such as possessing the time and money to get to the doctor.

The Universal Health Coverage does not get us out of the Woods

Countries like Germany and U.K. don’t face the high healthcare costs as patients face in the United States, but that doesn’t mean that money as a whole is not a problem in the lives of the impoverished in these countries. But then again, it turns out that managing the medical demands of low-income patients by itself still is an independent challenge.

The low adaptability of the current healthcare scheme to individual communities is universal to all nations. As we witness based on what described in Poliklinik Veddel und Gesundheit für Billstedt/Horn (literally, “Health for Billstedt and Horn”) underscore this point of the inflexibility of the system to adapt to different values.

There are too many variables in the global healthcare system to support a one-size-fits-all medical service for everyone. Government-imposed price control on healthcare costs does not suffice. Furthermore, the issues consumers and healthcare providers will have to sort through a variety of community challenges to fruitfully shape a better healthcare system.

In short, every nation faces its own hurdles in uttering healthcare, as the U.S. is hardly unique. One of the main obstacles to delivering quality medical care for all is deciding precisely how much the government should regulate costs and treatment decisions in a given healthcare system.

Some of the challenges facing the German system

Even though citizens of Germany enjoy having universal insurance coverage, nonetheless high rates of chronic illnesses such as diabetes, depression, and heart disease continue. At the same time, treatment and preventive care options are scarcely accessible to the destitute. Thus, the challenges faced at both outposts; Poliklinik Veddel and Gesundheit für Billstedt/Horn emphasize a point that national health, by itself, doesn’t serve as the magic bullet for staying healthy.

Life expectancy in deprived areas is determined to trace that of Hamburg’s wealthier neighborhoods by at least thirteen years. In Hamburg, such difference continues despite that residents never miss medication or ant clinic appointments because of cost.

Patient non-Compliance

Being complicated problems to treat, within the three years of operation, Gesundheit für Billstedt/Horn has provided care to over 3,500 patients (3% of the population in the two neighborhoods it serves). But only 50% of the people who show up for a first visit routinely return for a follow-up.

Photo by Creators Collective on Unsplash

Lack of Awareness

For one thing, many don’t realize the health outpost is real. For another, people don’t feel they can spare time from chaotic lives.

The German Poliklinik in Hamburg exploits social and community events like coffee meetings, events at the local church, and local movie nights to get patients in the door with inadequate success. Still, Poliklinik sees only around 850 unique patients every quarter, far short of the area’s 5,000 residents.

Community Diversity; a big player of Effective Healthcare Planning

The Veddel community is a diverse one- which makes it even more challenging to rely on one standard solution. Diversity is always accompanied by various perceptions, expectations, and priorities of every individual within that community.

Historically, governments have benefited from the convenience of profiling citizens into categories that gave subordinate newcomers into solidarity at the disbursal of giving up the personal identity or individuality. However, as diversity expanded, the community to serve as a Melting pot perversely and progressively have shifted.

Another limit on the clinic’s ability to satisfy the patient’s needs is facing a deficiency of doctors willing to work in poor neighborhoods. Theoretically, one could take public transportation to another part of the city to locate a physician, yet it involves time and money to commute.

Even decades of comprehensive Primary Care don’t Work

Although over the past few decades, global survival expectancy and healthy life outlook have increased, nonetheless, the course has impeded. Instead, trends move in the opposite direction for a particular group of folks.

The Alma-Ata declaration of 1978 marks the first of a good lead-in history, keeping up the vision of “health for all.” The grand view of the evolving health for all drive was principal to help people live healthier, lengthy, and thrive. Still, despite the prevalence of the presentiment, the mission is extensively diversified between the prevailing experts.

Primary care is a bureaucratic notion that solely converges on planting the hard bulk of duty burden on physicians who elected to have a broad skill set. It is aimed to reduce costs and create an organization.

The primary care idea was suitable to the 20th-century healthcare delivery system because patients held limited access to information. They had limited, or no proficiency in science and technology hence had feebler expectations. In contradiction, now, even the people under disadvantaged socioeconomic conditions have entrance to knowledge. As a result, the standard of care has been broadened, requiring more extended responsibilities to deal with by primary care physicians.

Primary Care and Value-based Reimbursement

Along with the new implementation of value-based reimbursement models, the concept of primary care and population health policies are not able to sustain a balanced “Scope Triangle” or the “Quality Triangle” of cost, quality, and time.

As opposed to what conveyed to us for years, there is no lack of primary care physicians. However, there are indeed sparse physician distributions among insolvent geographic, skillset, and socioeconomic distribution.

By forcing universal injunctions on physicians, the administrations are only striding to broaden the limited scope of medicine against providing given services that primary health physicians are capable of handling. The approach is going to upset the already unequal dispersion of standard of care across all socioeconomic and geographic borders even further. As an alternative, they must enforce quality, not license and certification; value provided, not by whom is being offered; distribute care instituted on abilities, not the profile of title.

There is a multitude of factors as it translates to health and a healthy lifestyle. Those necessities tend to vary from community to community and one country to another. In developed countries, including those with universal coverage, engaging individuals in their own health is still a big challenge. Because engaging patients is resource-dependent and often costly, if not done right.

Self-care is Medical Care

Old days, self-care would have been limited to washing hands and brushing teeth. Today is deemed a little short of self-prescription of medication and improved herbal treatments than conceivable before; to a lesser extent, reliance on physicians. A century ago, healthcare was nothing but medical care with un-subdivided take-home instructions. Thus, self-care remained the levelheaded restricted medical care of the self. Today self-care has lesser restrictions with broader limits and is expanding parallel with the technological perimeter. There appears to be a clash between the patient, physician, technology, and government parts; each is yet to find a dedicated space within the healthcare space.

Again, The Grass is greener on the other side of the Fence.

Affordable care act, Medicare for all, Single-payer system, national health plan all share one characteristic peculiarity; that is, the “redistribution of equity.” Other than that, the challenges stay the same irrespective of the socioeconomic status of countries. According to WHO the following problem is universal to almost every government, which requires proper logistics to coordinate necessary resources to better care for individual patients:

● Human resources Finances

● Infrastructure and supplies / Technology

● Knowledge and information

● Evidence-based clinical practice

● Leadership and governance

● Service delivery

● Contextual and population

● Principles and values

● Health service delivery challenges / Access

● Human resource challenges coordinating care efficiency

● Equity

We are Missing Definition on Health and Healthcare

It has been a prevalently accepted phenomenon that healthcare must be paid for by a third-party payer. However, to the contrary, it is indeed being indirectly rewarded for by the average citizens at a much higher cost than if the price was picked up directly by the patient through the open free market. No matter what we select as the carrier for a promising healthcare system, we must expect to assure that our legislation, the market, business models and medical ethics are in synchrony and synonymous with one another.

The Present-day Population Health does not suffice the Individual Demand

The public health administrators across the world have put forward a definite restructured article of the healthcare delivery model. They have constructed it to exhibit a predefined map of social determinants or components which categorically influence the outcome of human health, like smoking, drug use, poverty, etc. They have also proposed to produce a set of action plans designed to incentivize physicians and healthcare workers to engage the patient population on those determinants.

This modern population health standard, however, is the fusion of personalized healthcare and the traditional population health. Though it may sound fascinating and may even serve as a path in a positive direction, it is far from faultless.

Decentralizing the database is indispensable in healthcare

21st-Century Healthcare is in the midst of the clash between Expectations, Ethics, Law, and Business

Way too often, we are all inclined to accept or overlook the hypocrisy of our healthcare system. For example, we invent technologies we can’t afford to utilize. We find cures with which we can’t heal ourselves. We set prices on healthcare services too high, and yet we protest; it is too expensive. We expect 3rd party payers to meet for our healthcare, and we create entitlement programs where particularly abusers of the system serve from that.

If we think more clearly, we have the privilege of prosecuting bad people and placing them behind bars, but only if we pay for it. But those who genuinely need assistance (e.g., poor people) may even have to split their share with those in prison.

Certainly, offenders won’t put themselves away!

In the past, hard labor was the job of prisoners, but over time it was voted unethical and considered form slavery. Healthcare given to the prisoners is by the book, is legal, and solidified. Physicians treating them must also be qualified and knowledgeable.

The Root of the problem resembles the elephant in the Darkroom

The problem with the utmost prevailing strategies to understand healthcare problems is the propensity of the person to focus on finding the big solutions, and in turn, forgets to focus on the grassroots!

The after-mentioned resembles the elephant in the darkroom. In the latter case, different people focus on various features and come out with their own decision. The tale of the elephant in darkness, for example, converged on how six distinctive blinded men examined different parts of the elephant, from the trunk to the ear to determine what they felt was true; anything from a water pipe to a massive fan. Therefore, it’s vital not to be blind-sighted by our understanding and judge when we can look intelligently at the bigger picture; in this case, the entire elephant. It is not just medical unawareness, as it is also the social prejudices that continually contributes to the lack of treatment option. Gynecologists, for instance, may not appreciate the mental health problems of the patient during treatment.

Similarly, the Economy is not Enough

Undoubtedly, the economic status of any community is of utmost significance in establishing a proper healthcare delivery system, but what good does it do to the public as a whole, if we push money into a system that has no adequate grassroots infrastructure. Or the motivating a group of people holding individual profiles such as social determinants of health when that individual does not see him or herself within that category?!

Without a doubt, one should expect significant fiscal waste if the latter and similar infrastructural issues are not to be addressed. Consequently, throwing money at the healthcare system without ensuring grassroots sovereignty is destined to fail.

The position of OECD on the Economic Status of the Current Healthcare

According to the Organization for Economic Co-operation and Development (OECD), the demand for healthcare is expected to rise. The aforementioned means an uptick in cases of chronic diseases associated with aging, such as dementia, cardiovascular disease, and musculoskeletal conditions. For reasons of stake, most OECD countries have chosen to base their funding of healthcare mainly on public sources. There is a famous enigma of affordability, arising from the pressure between the readiness of the community to pay taxes and the eagerness of patients to use health services if these are free or heavily subsidized at the point of application. These anxieties are likely to be provoked by a surge of new medical technologies that inevitably add demand to the healthcare market.

Some historians have prophesied the decline of publicly funded healthcare systems under the new spending requirements. To overcome this obstacle, governments merely try to deploy a variety of policies on how to handle the increasing public demands. They do so by taking comfort by abandoning their core commitment to the community funding of health systems. Furthermore, in the face of ever-rising standards of living, they estimate that public and private insurers may find it more hospitable to collect the funds needed to pay for the health care expected by consumers.

Photo by Sharon McCutcheon on Unsplash

The Rising Cost of Healthcare

Healthcare Costs continue to rise, partly, as health services are labor-intensive. Equity in health status has not been accomplished even where there has been universal access to reasonable standards of healthcare for multiple decades. It is valid that equality of health status has been increasing almost everywhere. In fact, there has been an awareness regarding the average age of death. More citizens are living what has typically been marked as a full life extent. Nevertheless, many have not kept up with the general advances in health standing.

The growing indication of the tenacity of health disparities, notwithstanding universal access

to adequate medical care, has been one of the reasons for a rethinking benefit of the traditional population health standards.

Another reason for the population health failure is the extension of evidence about important personal factors such as education, lifestyle, and environment.

In retort, multiple nations are evolving preventive and population health strategies to tackle the root origins of the disease burden. Administrations have utterly underestimated the future consequences of indiscriminate funding universal health coverage. Instead, many governments had taken on the weighty responsibility of financing comprehensive medical care at a time when there were relatively few effective medical procedures.

Some winnings may be gained through improved public health procedures and some through improved personalized healthcare, as some postulate. Although initially, new technologies tend to be more costly than the ones they supplant, in the medium to long term, their relative prices usually diminish. At the same time, the rate of take-up is intensified. Concerning affordability, there is wary confidence partly about the chances for a long stretch of stable economic growth a sustainable ‘long boom’ in the world marketplace.

Healthcare Problem is only One

Healthcare is one big scapegoat of defeats of defining what the authentic quality and value are! Many erroneously offset the universal third-party healthcare coverage to the quality of medical service. In contrast, others dislike the services they obtain if they are not in line with that of their personal desire. Healthcare has been somewhat implicated by the business fads. For instance, Germany, with the long history of premium healthcare delivery system in the European continent, and provider of health insurance for all, nevertheless maintains its own distinct hurdles.

Coronavirus crisis czars: Politicians Versus the neo-aristocrats

As pointed out earlier, the 21st-century healthcare crisis is not particular to the United States. It is a problem encompassing the blunder of conveying individual expectations in the world but based on the quality and value determined. “Not” under what expressed by the administrators. Under urgency within the spectrum of the given social concerns, the personal benefits or perceived quality may stand less critical for the economically deprived. For instance, for those who are striving financially to make ends meet, any form of necessary medical service would be deemed a plus; nevertheless, that does not mean equal to better quality.

While the world’s legislators are working to maximize patient satisfaction and quality care, yet the system is flunking on every ground.

Poor Healthcare Policy and Medical Nihilism

If not recognized, the after-mentioned would be a predisposition to individual medical Nihilism. But Nihilism is a vital face that every patient holds that potentially threatens their association with the treating physician.

The scheme has conceded that the time for the revival of personalized healthcare has arrived.

The healthcare enactment has been trying to implement a value-based reimbursement service that includes publicly displayed patient satisfaction inquiries. But the fundamental criticism points to the policy failure to efficiently factor in the personal elements of the medical service quality. The prevailing medical system is yet banking on fictitiously driven social determinants based on statistical proceeds. Therefore, the hybrid version of population health utilizing partial patient engagement is the ground for the precipitated clash of expectations with obsolete protocols and procedures.

Healthcare Problem needs a Personalized Solution.

The most unique feature of human beings is their individual problem-solving ability. Along the way, he or she must strive to make life simpler, healthier, more convenient, and prosperous. Humans must also appoint compelling leadership, where at times, a leader must make decisive choices. The power of collaborative efforts over consolidative undertakings must often be realized. Partakers must be able to offer solutions independently towards the same goal. It entails honoring the autonomy of its elements within the grassroots. There comes another impediment, as amidst problem-solving to curb over-simplicity, and mistakenly confused between simplicity and making shortcut; or for any distinct reason. What just described is the epitome of a scheme that standard administrations fail to follow.

Despite their verbal support of personalized approach, health administrators’ actions are directed towards further complicated when they should try to simplify the problems. They are focusing on Top-down strategies in healthcare when what they should be doing is strengthening the grassroots. Likewise, they are supposed to address individual factors of health; instead, they are further categorizing determinants of disease in clumps downplaying the genuine quality and value of medical service to the individual patient.

Everyone deserves an equal Opportunity to Quality Healthcare

The state of sufficient passage to opportunities to everyone, aimed at reaching an affluent lifestyle is essential. One can vaguely anticipate anyone denying the crucially of any given individual opportunity. Equal chance is where everyone attended the same, deemed unharmed by bizarre impediments, prejudices, or preferences. Every soul warrants to have entrance to the spectrum of possibilities that encourage them to live healthily and comfortably. Notwithstanding, the circumstances are different among different people and societies. Personal posture, as well as the interactive conformity between citizens, is the top influencer of what is regarded today as equal opportunity and individual sway.

Irrespective of the socio-political ideology, to implement a quality healthcare program for all, first, we must realize the defining junctures of what an individualized authority signifies. The significance of inversely proportional interrelationship between cultural diversity, size, economy is essential.

Additionally, the Nordic healthcare model can thrive, given the uniformity of widespread citizen expectations; Something that is missing in Poliklinik Veddel und Gesundheit für Billstedt/Horn. To solve the problems such as described for the Veddel district in Hamburg, first, we must start by respecting individual identity within the community.

Any government mandate should be aligned with the principles that focus on ensuring public safety, individual identity rather than manipulating clinical judgment and micromanagement. The aim should be to macromanage. All in all, the government, accountability, and transparency should be taken as the virtues to avoid falling into the trap of corporatism.

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Adam Tabriz, MD Dr. Adam Tabriz is an Executive level physician, writer, personalized healthcare system advocate, and entrepreneur with 15+ years of success performing surgery, treating patients, and creating innovative solutions for independent healthcare providers. He provides critically needed remote care access to underserved populations in the Healthcare Beyond Borders initiative. His mission is to create a highly effective business model that alleviates the economic and legislative burden of independent practitioners, empowers patients, and creates ease of access to medical services for everyone. He believes in Achieving performance excellence by leveraging medical expertise and modern-day technology.

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