1

Daniel Firayner

The Goldmine of Chronic Care:

How it Ruined the Quality of Healthcare

Introduction

The medical field affects us all. Even if you have no interest in a medical profession, one day,
you will end up in the hospital or a physician’s office. In that case, do you not want the best
possible quality of care at a reasonable price? Currently, that is not the question on the minds of
those in charge of healthcare.

As one of the most lucrative business structures, the medical field assumes the position of being
a revenue-driven market. With an almost unlimited demand, granting the power of medical
money flow to savvy businessmen/women instead of doctors is sure to lead to a profit. This is
especially true with the current state of chronic care, which prioritizes continuous and expensive
procedures that simply delay a never-ending illness. This in turn not only allows providers to
charge any fee that they wish, but other non-chronic treatments are no longer as valuable and
must also increase in price.

Now more than ever, revenue has driven all the pillars of healthcare to a steady decline and the
system in place becomes more outdated each day as other nations continue to advance. Most
countries follow a nationally based healthcare system that aims to provide adequate care to
everyone in the population.1 While some countries may take a different approach, most European
and developed nations share this common goal of unified care.

The outlier here is the United States, which lacks a unified structural model, leaving room for
profits and gaps in access. While financial incentives are often very effective, it is clear that as
the strive to profit from patients with chronic illnesses increases in the medical field, the quality
of care decreases, the access to providers diminishes, and the cost of medical services surges.

1
Liji Thomas, “Healthcare Systems around the World,” News-Medical.net, April 6, 2021
 2

The Quality of Our Care Decreases

The United States is one of the leading nations in almost every financially-supported category
such as military, innovation, etc. However, when it comes to healthcare, the US tends to be one
of the weakest out of all of the world’s developed countries. This can be seen through the United
States’ lack of long-term health outcomes such as treatment outcomes, patient safety, and patient
experiences, it is clear that the American health system provides lower-quality care than other
nations alike.3 These factors are distinctly true (infographic 1) even though the US spends double
to triple what similar nations spend per capita. This result is mainly caused by the system that the
US employs, as it strictly prioritizes revenue and there is a very minimal amount of
compensation allotted for quality. This system leads to physicians rushing through patients to
achieve a decent wage, with hospital administrators only incentivizing doctors to deliver as much
revenue out of patients as possible.4 Furthermore, chronic patients get priority as they are the
most profitable and likely under well-paying insurance. On the other hand, the uninsured, and
those who are simply looking for care that is not as profitable for the providers, are left out and
usually rushed.
2
Mary Mahon and Bethanne Fox, “US Health System Ranks| Commonwealth Fund,”
Commonwealthfund (commonwealthfund, 2019)
3
Nisha Kurani and Emma Wager, “How Does the Quality of the U.S. Healthcare System Compare to
Other Countries?,” Peterson-Kaiser Health System Tracker, September 30, 2021
4
David C. Dugdale, Ronald Epstein, and Steven Z. Pantilat, “Time and the Patient-Physician
Relationship,” Journal of General Internal Medicine 14, no. S1 (January 1999): S34–40
 3

The Access to Providers Diminishes

The uninsured community has been a historic issue that has a devastating impact on many
communities such as low-income populations, minorities, and many rural communities. The
reason that such a large portion of the nation is uninsured is due to the U.S. uses a national
single-payer health insurance instead of the universal health care system that most other nations
employ.6 This means that every citizen is responsible for their own insurance coverage, and while
the government does help many individuals who cannot afford insurance, there are many holes in
this system. Some people may not have access to resources, and others may fall between the
lines of too much income for Medicaid and not enough income for private insurance. Why does
the US not just employ a universal system to get rid of these gaps? One of the major reasons is
that with a malleable insuring system, providers can make tremendous profits off individuals
with chronic illnesses. For example, individuals who have a chronic condition and choose
deductible-based plans tend to spend hundreds to thousands of dollars out of pocket just to be
insured.7 In turn, even those without chronic illnesses will also have to face the inflated prices
that this market has made, leaving a large gap in coverage and access due to a desire to profit and
prioritize those with preexisting conditions.

5
CDC, “CDC VitalSigns - Access to Health Care,” Centers for Disease Control and Prevention, January
6, 2020
6
Michael Carome, “Dead Last: U.S. Health Care System Continues to Rank behind Other Industrialized
Countries,” Public Citizen, November 1, 2014
7
Kara Gavin, “Health Plan Deductibles: Health Care Costs for Chronic Illnesses,” January 10, 2017,
 4

The Cost of Medical Services Surges

Technological advancement is a very costly investment but can also be very effective in medical
practice. However, while the US is very successful in terms of technology it still ranks 6th in
innovation as of 2021.9 Yet the US spends almost triple what an average developed nation spends
on their healthcare per capita. Realistically speaking, with such a staggering investment, the US
should be the top innovator for chronically ill patients, but the current state of medical work
prioritizes revenue instead of treatment. However, about 30% of this spending is used simply for
administrative costs, and another 30% is split amongst profit-orientated streams.10 This turnout
makes it clear that most of the difference in spending as compared to other nations is simply used
to increase profits and not benefit patients. As a result, hospitals and providers can continue to
prioritize chronic patients and surge prices, which will in turn affect the average healthcare user
who may not have a chronic illness or may need to pay out of pocket. Without support funding
for the rest of the population, the goldmine of chronic care drags the prices and spending of the
entire healthcare system, affecting all patients.

8
Per Capita Healthcare Costs — International Comparison, “Per Capita Healthcare Costs — International
Comparison,” Pgpf.org (pgpf.org, 2019)
9
Avik Roy, “United States: #6 in the 2021 World Index of Healthcare Innovation,” Medium, June 25, 2021
10
Ani Turner, George Miller, and Elise Lowry, “High U.S. Health Care Spending: Where Is It All Going?,”
www.commonwealthfund.org, October 4, 2023
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Viable Policies to Address the Issue

Chronic Care Treatment Plan

The first viable policy would be to create a permanent program that would be prescribed to all
patients who are diagnosed with chronic illnesses. This program would regulate the way different
patients are treated and will approach chronic illness in a more collective treatment method.
Currently, there is a drastic gap in the long-term care policy industry, as about 70% of elderly
patients require these services, and only 3 to 4 percent are signed to a policy.11 Having a federally
funded program ensures that those who will be in need of long-term care, essentially due to
chronic illness, are provided with the necessary resources. Creating a standardized plan will help
to illuminate the inflation in the current healthcare market that is driven by the current care
procedures for chronic care. This program would not only eliminate out-of-pocket costs that
plague patients but will also ensure that every patient interaction is prioritizing treatment and not
financial gain. All prices and plans will be pre-negotiated between the government and
providers, eliminating the power that insurance companies and hospitals have over vulnerable
patients.

Many European nations have adopted systems that aim to separate chronic care from the rest of
the healthcare field and place more focus on integrating self-management support for patients.12
While this may reduce profits for providers, it places the care of the patient first. These financial
disparities can be settled with subsidies, removing the burden of payment from the patient.

Expansion of Medicaid

The second policy alternative is an expansion of the current Medicaid system, which would help
provide more citizens with access and insurance. Currently, Medicaid has strict guidelines for
entry and many citizens do not qualify yet cannot afford private insurance. Specifically, over 1.6
million adults are considered low-income individuals who are not yet eligible for Medicaid.13
Therefore, a tier system of Medicaid would solve insurance gaps by providing different levels of
support based on need. Those who fall into the lowest tier would have the greatest insurance
assistance and others who may place higher but still qualify, will be granted partial assistance.
This would, in turn, create fewer gaps in insurance coverage and would help open more access to
medical care.

11
Jordan Rau and JoNel Aleccia, “Why Long-Term Care Insurance Falls Short for so Many,” The New
York Times, November 22, 2023, sec. Health
12
Ellen Nolte and Cécile Knai, Approaches to Chronic Disease Management in Europe,
Www.ncbi.nlm.nih.gov (European Observatory on Health Systems and Policies, 2014)
13
Center on Budget and Policy Priorities, “The Medicaid Coverage Gap: State Fact Sheets,” Center on
Budget and Policy Priorities, March 3, 2023
 6

Preventative Treatment

14

The third policy would be to create a stronger inclination toward preventative treatment as
currently, the US only spends about 3.5% of its healthcare budget on preventative services
(infographic 5). This proportion is staggeringly low and greatly increases the risk of patients
developing preventable diseases, which is most likely caused by the nation’s profit-driven
system.15 One of the main reasons these procedures make up such a low proportion of spending
is that the payout to physicians is very low. This means that there is much less of an incentive for
doctors to prevent diseases instead of treating them. In turn, many patients struggle with chronic
illnesses (that may have been prevented) for the benefit of providers who are able to gain
life-long clients. However, patients with no insurance are also left with no incentive to go in for
checkups or screenings as they would have to pay a hefty sum for these services, making them
practically unavailable to uninsured populations.

What the current system needs is a move away from a perpetual cycle of treating the same
patients and a shift towards ensuring that people stay healthy. This potential solution would first
implement positive changes to the social determinants of health.16 These policies would

14
Bianca Gordon, Jessica Chang, and John Hargraves, “Spending on Preventive Services Represents a
Small Fraction of Total Health Care Spending, but Costs to Individuals Could Be High without ACA
Protection,” HCCI, October 12, 2022,
15
Feras A. Batarseh et al., “Preventive Healthcare Policies in the US: Solutions for Disease Management
Using Big Data Analytics,” Journal of Big Data 7, no. 1 (June 23, 2020)
16
CDC, “Frequently Asked Questions | Social Determinants of Health | NCHHSTP | CDC,”
www.cdc.gov, December 19, 2019
 7

influence the environment around citizens and would help to eliminate behaviors and harms that
can negatively impact a person’s health.

Another aspect of the policy would be to increase funding for preventative treatments as well as
make certain screenings (such as ones for cancer) mandatory in the same manner that certain
vaccines are mandatory. These screenings and visits would be free for all patients and subsidized
by the government.

Overall, both impacting the social determinants of health and also creating an incentive for all
stakeholders to partake in preventative treatments would shift the focus of the US healthcare
system to treating patients instead of generating revenue. This new policy can help to bring down
prices and increase compensation which would in turn decrease future patient visits, thus
decreasing total spending.

Conclusion

Access to a functional medical system is a human right that is instilled in every developed
society. However, the US seems to fail to provide adequate care to its population due to a
healthcare system that is solely oriented around generating revenue and not curing patients. With
chronic illness being such a major segment of the medical world, it is not surprising that the
financial minds in the medical field have used it to their advantage. The quality of care has seen
a decline as well as a decline in access to care, all at the same time as costs have skyrocketed.
Policies need to change but implementing them will take years, if not decades of effort. The
medical field is very complex and many obstacles prevent change, however, a push for a just
healthcare system is paramount and needs to start now. Both policymakers and providers must
join forces in order to form a system that cures patients and prevents future illness.
 8

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 10

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