The Four Problems of Healthcare: I Don't Get What I Need

Dr. John Espinola
Tuesday, October 31, 2017
A man in the office.


The adage, “You get what you pay for” works in many parts of the consumer economy. Sadly, that's not the case in healthcare. Part of the problem, as we outlined before, is the cost. And another part of the problem is patients paying for what they don't need - something we will address in the next post.

Yet a huge and often under-reported problem is the millions of patients who do not get care that they actually do need. People call this “under-utilization,” which is really just a fancy way of saying you're not signing up for some important yet often inexpensive treatments that can keep you well.

According to the Center for Disease Control and Prevention, Americans use preventive services about half the time they should. There are real health consequences to this neglect, and it is putting people in danger.

For example, nearly 10,000 deaths from pneumonia could be prevented each year with a one-time vaccination. Yet about 40 percent of those 65 and older fail to get the shot. Vaccination rates for infants and children are much higher, but the stories about measles outbreaks in recent years prove we still have a ways to go to make sure the little ones get these essential shots.

Another study showed that only one in 20 women are consistently getting an annual breast cancer screening mammogram, even though regular mammograms are clearly associated with reduced risk of death from breast cancer.

It's clear that many people miss out on simple steps that are proven to improve long-term health. In future posts, we'll talk about what Premera is doing to encourage vaccinations and proven cancer screenings

What We Want For Patients

Here at Premera, we'd actually like it if our members didn't have to think about these problems at all. Our purpose is to help solve them so people don't have to think about these things when they go to the doctor's office. Instead, they can focus on being a patient and getting well.

John Espinola, MD, MPH is the Executive Vice President of Healthcare Services


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