Look, while I am a big supporter of universal health coverage (UHC), went to med school and currently work as an ER doctor in countries with UHC, and think that the USA has the worst healthcare system imaginable, overuse of healthcare is a legitimate and extremely exhausting problem. I think privatizing healthcare is insanity, but you need to set certain structures in place to avoid overuse of healthcare services.
Let me start with an example.
I, as a single doctor in my ER, can see up to 250 patients in a single night. Only around 20 of these are actual cases which need to come to the ER, the rest are often any of the following:
people who don’t want to wait in line at the polyclinic during the day
people who are bored (not a joke, they feel like “getting checked up”)
people who want a “doctor’s note” to get off from work/school
people who went to a doctor during the day, got examined, diagnosed, received a prescription, but they don’t magically feel good after only taking one (1) pill
people who feel like they might get sick soon
I practice medicine in a different language, with a different culture. this is hard to describe but long story short, a significant percentage of the population believe that they need an IV saline infusion (basically salt water) to get better. they crowd ERs to get IV infusion and leave dissatisfied when we determine they don’t need it
And for fun, some very funny things i encountered:
Someone brought his kid to the ER saying, and I quote, “My child is too short”
Someone came to the ER for foot fungus
Someone brought their kid saying “he doesn’t sleep at all”, during my examination when I asked about the reddened eyes of the kid, they said “oh he just woke up”. Apparently, the kid fell asleep while they were getting ready to leave the house, and since they were already dressed, they decided to wake him up and bring him to the ER.
These are ER examples, since I work in one at the moment. However, during my med school years, I also worked in many polyclinics and they are also similarly overcrowded for various reasons.
Again, they often come to get doctor’s notes to get off from work/school.
One time I created the file of a patient for over an hour, did a full exam, work-up etc., diagnosed him and told him what it was, for him to tell me that he “already had a diagnosis from another doctor”, but didn’t tell me because he wanted to see if he and i would say the same thing.
Now, one factor is the general health literacy of the population, which isn’t very good here (and considering the education system in the USA, and the fact that anti-vaxxers are such a big problem over there, I’m pretty sure it’s not that good there either).
The other factor is the importance of establishing a strong and organised family physician system, which needs to have a referral structure set in place.
In Turkey, there is “mandatory service” for doctors as family physicians, therefore there is a high number of family physicians to provide these services. most family physicians have 3000+ patients they are responsible for, and this includes their vaccinations, regular examinations, their referrals etc.
However, the patients don’t need to have a referral from their family physician (which is a primary healthcare service) to go to a higher level center. A university hospital is a tertiary healthcare center, for example, where only the cases which can’t be solved at lower level centers should be treated.
Since there is no referral system, instead of going to their family physician, the patients go directly to university hospitals, or other larger hospitals they deem “more adequate” and crowd these places. Going to a university hospital to get a rash cream is a waste of everyone’s time, for example.
The proper order should be something like this: you live in a little town, have a stomach ache that won’t go away --> you go to your family physician, which has been your physician for years and knows your general health condition well --> he runs basic tests, examines you, determines if he can or cannot treat you --> if he decides that you need a referral, he refers to you a secondary healthcare facility, maybe at a nearby bigger town --> they examine you at this new center, if they decide they can’t help you they refer you to a university hospital where the most advanced doctors work and they have the most advanced technical capabilities
when you don’t have a referral system, people tend to go to the biggest hospital they can think of, for any and all complaints. this leaves the family physician offices empty, which is a waste of their time, and crowds the larger hospitals with less severe cases, delaying the detection and treatment of actually complex cases.
In addition to going to hospitals for even the smallest (or sometimes nonexistent) reasons, there is also the fact that you need to have preventive medicine and encouragement of healthier lifestyles.
One of the most common thing I encounter is diabetes, followed by hypertension, hyperlipidemia (high cholesterol), and heart disease.
These are often results of unhealthy life choices, and their clinical symptoms greatly improve with lifestyle modifications. (I’m not saying they don’t need treatment, of course they do, but you can’t expect to eat 5000 calories every day and be perfectly healthy with 2 little diabetes pills) (unless you’re an athlete, or a bodybuilder etc.)
Now, the reason why I’m working in the ER now (and why I will go into surgery soon) is that I like to be the determining factor in my patients’ health. It makes me sad and frustrated that even though I do everything I can possibly do, my patient can die because they simply refuse to follow treatment.
Anyway, going to another important factor in overuse of healthcare.
The doctors get used to having all diagnostic tools available to them. We used to order CTs, MRIs, scintigraphies left and right back when I was in a university hospital. Which is all well and good when they are necessary, however it’s been leading to some doctors relying entirely on lab and imaging results, instead of properly examining their patients.
I literally had no idea how much each of these imaging studies cost, it was always free, so we just never had to worry about them. I realised when I was working in an ICU that for each patient, we spent around 6-7k USD per week. This does not include the imaging studies, only the labs, machinery etc. Doctors need to be trained better to not overload this system.
This is getting long, and I have work in the morning, so I’ll wrap up:
Privatizing healthcare is dumb
Universal healthcare coverage is a human right and should be implemented everywhere
however if you do this without properly planning it, it can lead to a lot of issues
some of those are related to the general educational level and healthcare literacy of the public
some of them are related to logistics
some of them are related to the education the doctors receive
while it is perfectly okay to make fun of idiots who are afraid of UHC, please don’t overlook actual potential problems which need to be carefully evaluated while switching to a different healthcare system
