5 Steps to Restore Trust in U.S. Health Care_KFreed

I chose to review 5 Steps to Restore Trust in U.S. Health Care by Richard Isaacs (2022) for this assignment. This article discusses the importance of trust in public health and the well-being of individuals. I was drawn to this article because of the shortcomings of the American health care system that we have discussed in class, such as the country not having universal health insurance. The article explains that there is a direct correlation between exceptional health care experiences and quality health outcomes, which are rooted in patient/provider relationships. People who do not trust the health care system are less likely to be forthcoming during physician interactions and therefore are less likely to comply with medical advice and prescriptions, undermining patient health. 

Isaacs (2022) describes the declining nature of general trust in the U.S. health care system, which he argues was strongly influenced by the COVID-19 pandemic. Pandemic-related factors leading to health care system mistrust include: changing directives, lack of coordination between the local, state, and federal levels, as well as the prevalence of health disparities among minority populations – specifically Hispanic, American Indian, Alaska Native, and Black people. Minority populations suffered higher rates of COVID-19 infection and death than the White population. The article also notes that some areas of the country were forced to rely on outdated technology (i.e. fax machines) to send and receive COVID-19 test results, which was not feasible for individuals without access to such technology. Similarly, many rural populations tend to be older, poorer, and have more underlying conditions than more metropolitan populations, and unfortunately these rural populations were often left with fewer sources of reliable information about COVID-19 and health care directives. This led to lower vaccination rates among rural populations than metropolitan or urban populations. 

The article provides five key steps to enhancing trust in the American health care system: (1) support the move to value-based care, (2) reimagine the public health infrastructure, (3) leverage technology to improve access, (4) shift more hospital-level care into the home, and (5) cut the red tape and keep patients engaged. Step 1 refers to moving away from the “fee-for-service” model in health care, and toward prepaid value-based care in effort to give organizations flexibility to improve health care delivery. Step 2 refers to allowing health care technology to more seamlessly integrate communication among public and private health care institutions to improve health care affordability, access, and support for population health initiatives. Step 3 refers to improvements in telehealth to enhance patient accessibility and convenience. Step 4 refers to in-home advanced care when possible for better patient experience, as well as better service in hospital settings for patients truly needing the hospital setting. Step 5 refers to ensuring patient voices are heard and physician understanding of patient priorities and values.

In theory, I feel these steps sound like great ways to restore trust among Americans in the health care system, although I believe there are many complexities for implementation not accounted for, specifically in regards to steps 1, 2, and 5. First of all, a prepaid system becomes a gray area when individuals cannot afford paying into the system. Affordability of health care is already an issue in the U.S., and so I feel the only way that this idea would be beneficial is if the system was prepaid through government funds. This somewhat reminds me of the infrastructure of the National Health System (NHS) of the United Kingdom that we learned about in the PBS film. Secondly, the idea of better integration between private and public health care systems sounds great, although I wonder how feasible this is due to how the U.S. private and public sectors currently operate. Generally, the private healthcare system is only accessed by people who have the financial means to do so (i.e. those covered by health insurance often through an employer or those financially-able enough to pay for out-of-pocket private services). Medicaid and Medicare are often more highly utilized in the public sector, but not to say that there isn’t some cross-over. With this generalization, it seems the biggest benefit would come to those who already have pretty good access to health care, but little effect on people with already-limited access. I feel it is important that our current health care efforts work toward improving the quality of care for individuals at the highest risk and lowest access – which unfortunately tend to be within the same population. Lastly, step 5 is well-intended but I believe is harder to regulate on a health care system perspective, as it comes down to individual patient and provider interactions. All in all, this article may be helpful for individual physicians and other health care providers to read and implement some of the practical steps, but overall the steps do not seem to transfer application to the system as a whole. As I previously mentioned, I believe more emphasis and health care improvement efforts should be put toward our most at-risk populations and those with most limited health care access; as it is important to build the trust of these groups to gain positive health outcomes.