What are the biggest problems facing health care, locally and globally?

[MCAT guy]

For our generation, what will be the biggest problems for people getting quality health care both in the US and abroad?

Feel free to mention any good books on the subject.

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[deleted357625]

health care disparities is a national issue.

 

[JubJub603]

The Healing of America by T.R. Reid is a great book on the subject.

 

[AlexMorph]

badgers

 

[raginfly]

too many old people

 

[Nymphicus]

This thread is going places

 

[Mbeas]

URM is the problem.

ok, thanks troll

inb4b&

 

[MDBankai]

lack of options for preventative care, especially in private practices

 

[MCAT guy]

I wonder what the solution is for the primary care problems.

We really can't expect people with 200k in debt @ 7% to go into FM. Lower debt or higher salary for family docs.

 

[LizzyM]

The older the age group, the higher the incidence (new cases) and prevalence (all cases) of cancer, heart disease, stroke and problems related to mobility, sight and hearing.

Consider that the baby boom generation is approaching 65 and over the next 20 years a large bolus of the population will reach age 65 and beyond. This will put tremendous demands on heath care.

Smaller families and a substantial number of single adults and divorced men estranged from their children means end of life care options will be restricted for many patients.

An associated issue in some countries is the collapse of the birth rate. This will change the demands for pediatric and OB care.

 

[gravitywave]

globally, the growing incidence of "diseases of the affluent" as nations develop and their citizens get heavier. T2 diabetes, CHD, CVA, asthma/allergies will all be on the rise in developing nations as the standard of living rises.

also, China is going to get hammered by lung cancer/COPD, AIDS and hepatitis. these are huge public health threats that are knocking at the door, and the government isn't lifting a finger to try and slow them down.

 

[kcin]

Obamacare

 

[Pons Asinorum]

The populations of first-world nations are getting much older while the cost of life-extending therapies continues to grow due to technical complexity. There are fewer young workers to pay that bill. Third-world trends will continue to move in the same direction; every time someone in the third-world doesn't die in childhood of some now-preventable disease, it means there will most likely be an older person down the line needing cancer or heart therapies, both of which are getting more expensive, to stress the ability of the global health care delivery system to meet that need.

 

[Long Way to Go]

Gas is too damn high.

So is rent.

Another one to add on to the list: drug-resistant strains of bacteria and viruses.

 

[BushidoBrown]

People who can't come up with original responses to secondary application essays

 

[DancinSarah]

Medicare will become insolvent in less than 10 years if nothing is done about it.

 

[MCAT guy]

It seems lots of the problems facing health care will not be things that physicians deal with, but more that politicians deal with.

I remember hearing a speech about doctors being in the senate. When the senate started there were something like 10 or 15% physicians in it (I can't remember the exact %), then 25 years later it got cut in half, then again it got cut in half in another 25 years, on and on. Now there are hardly any doctors that will be voting on these things.

It seems like on the America side at least, if we could just get some excellent policies in place that things could be improved greatly for our nation.

Overseas is different, as they seem to just need basic health care in some of the 3rd world countries to prevent diseases that are easily curable with the levels of care we have here.

I think we are all entering this field at an exciting time, but we have a lot of responsibility because big changes need to occur. And we will see who will drive the decision making, we can either let profit drive the decision or let the well-being of our future patient population.

I'm not quite sure how you handle these older populations though. Atul Gawande wrote a pretty good piece on "letting go." It's hard to know how much we will need to spend on these patients and what is acceptable. There is definitely a point when spending more and more becomes ineffective.

 

[MCAT guy]

The thing is there are programs to help people get reduced debt if they agree to be primary care doctors in certain areas but I think a larger problem is the distribution of doctors. Let us be honest with each other. Do people really want to live in rural america? Do people really want to live in the poorer inner city areas of big cities? or do people want to live coastal like in california and florida or east coast and in big cities like chicago, nyc, etc. or the neighboring suburbs?

I agree with you in that, these debt reduction programs aren't desirable because they force you to give up your freedom. It is one thing to give incentives to join a specialty and another thing entirely to say you have to practice in the follow list of cities... I will need to read more on specifics, but locking down a contract for a decision 4 years in the future is hard to swallow since anything can happen between now and then.

My money is on the latter of those options.

Yet the disparities are in the inner city areas and rural areas and amongst people most people don't want to live amongst. Same is true with education. so the problem won't be solved evne if FM docs are getting debt reduction.

I think a general debt reduction program for FM would actually help somewhat.

Furthermore, even if money isn't your primary reason for going to medical school consider the following
1. the reality is when you know that a CRNA or other people with half your education make more money then you as a FM doc,
2. many of your patients are non compliant and not really helping the situations, 3. for many FM is rather boring

This is where I have no problem with limiting pay of some things in medicine. It doesn't make much sense for CRNA's to be paid more than a FM doc. It is what it is but primary care is an important part of a health care system and I don't think it would be the worst thing to limit the pay of some other areas in favor of paying more to PC to keep preventive medicine strong.

Then you have the reality that most will not enter the field of family practice/general practice.

However, primary care is more then just family practice. Ob/gyn, internal med, pediatrics, and you have a fair amount of people entering those fields still. Real question is what percent of peds and IM residents go onto specialize and what percent remain as primary care general IM and general peds docs. It would be itneresting if we had those kinda statistics.

Those stats exist. NRMP fellowship data. http://www.nrmp.org/fellow/match_name/index.html

 

[MOHS_01]

Scarcity. The same problem that plagues all human endeavors.

 

[ChRcc]

The expanding population will strain the existing system, and the disparity between the rich and the poor will also prove to be a major problem. One example, which I'm worried about, is the possibility of the poor not being able to see a doctor for a major communicable disease. Everyone is entitled to health care, whatever their personal situation.

 

[MOHS_01]

The expanding population will strain the existing system, and the disparity between the rich and the poor will also prove to be a major problem. One example, which I'm worried about, is the possibility of the poor not being able to see a doctor for a major communicable disease. Everyone is entitled to health care, whatever their personal situation.

 

[hithere3387]

The expanding population will strain the existing system, and the disparity between the rich and the poor will also prove to be a major problem. One example, which I'm worried about, is the possibility of the poor not being able to see a doctor for a major communicable disease. Everyone is entitled to health care, whatever their personal situation.

While I'd agree that it's possible that someone with a major communicable disease goes untreated, if it's a serious threat to the population at large, it will be controlled. The general population (and therefore, the government) has a humongous incentive to ensure that communicable disease isn't easily spread. About 2 years ago, there was an H1N1 scare. I seem to recall governments around the world stock-pilling antiviral drugs.

Further, I tend to disagree (as I know MHOS_01 does) with the notion that everyone is entitled to health care. And, honestly, I don't understand what the fixation is with phasing like, "health care is a right" or "everyone is entitled to healthcare." This isn't to say that I don't think we should find ways to expand coverage. There are plenty of good reasons to keep people healthy that have nothing to do with rights.

 

[Pharmavixen]

End-of-life care.

 

[Sneezing]

Which brings up an important point. The biggest problem locally and globally is the belief that medical care is a right. This is the gateway to uncontrolled spending and costs.

 

[bronx43]

End-of-life care.

Actually, contrary to popular belief amongst medical students, physicians, and other health professions, outpatient care is a bigger contributor to our rising health care costs.

 

[GH253]

Bad economic theory will continue guiding policy in the wrong direction until we totally destroy ourselves.

 

[hithere3387]

Actually, contrary to popular belief amongst medical students, physicians, and other health professions, outpatient care is a bigger contributor to our rising health care costs.

would you mind elaborating, or sending me some place that would?

 

[Pharmavixen]

Actually, contrary to popular belief amongst medical students, physicians, and other health professions, outpatient care is a bigger contributor to our rising health care costs.

Aging boomers are going to make end-of-life care the most important medical problem IMO.

Drivers behind rising health care costs:

• Technology and prescription drugs;
• Chronic disease;
• Aging population;
• Administrative costs.

 

[MOHS_01]

Actually, contrary to popular belief amongst medical students, physicians, and other health professions, outpatient care is a bigger contributor to our rising health care costs.

On an absolute basis I would not doubt this, but where do you pull this information from? Also, as others have pointed out, the problem of rationing at end of life will likely become more prominent as the population wave propagates.