Access to healthcare in South Carolina is in need of a large band-aid. South Carolina happens to be one of the unhealthiest states in the Union by reports with a ranking of 46 out of 50 in the nation. This low ranking may be in part to the lifestyle and genetics of the population, but very likely the resident’s poor access to quality healthcare is a determining factor. Poor dietary habits, a diet traditionally rich in fatty and fried foods along with the general lack of exercise by the vast majority contribute to this but can be overcome with proper preventive medicine interventions.
Syndrome X (Metabolic Syndrome) is rampant in the southeast, hitting SC very hard with large populations of those suffering from hypertension (HTN) and diabetes mellitus (DM). Lack of access to basic healthcare mean hypertension, diabetes and other disorders go unrecognized and thus untreated. Ramifications of untreated HTN and DM alone can account for great morbidity among the population, leading to heart disease, renal failure, stroke, and blindness to name a few outcomes. This population of under-treated will eventually consume a greater healthcare dollar as their disease process worsens and sequelae materialize.
Statistics show some 19.4% of those living in South Carolina are uninsured, having no type of health insurance at all. From a 2002 report, the uninsured residents cost the healthcare system upwards of $1,936 per individual per year. While 60% of the uninsured are hard working citizens, the vast majority (74%) when asked list “affordability” as the reason for not obtaining or purchasing health insurance. About half the eligible individuals without health insurance do not enroll in public programs for two chief reasons; firstly, they don’t want to receive government support and secondly, they don’t want government to provide health coverage.
The problem goes beyond the individual residents of the state. Almost 80% of businesses in SC, excluding self-employed and government workers have fewer than 10 employees and 53% of these “small employers” with a work force less than 10 employees do not offer group-sponsored health insurance to their employees because of cost issues. Now that the problem has been identified, what is the solution? Well it is a complex and multi factorial problem to solve. Should the government step in and cover the cost of supplying healthcare to all individuals at great expense to the taxpayer? I say no. A resounding no! For the most part we see the failures in the system of government sponsored or supplied healthcare with what is currently going on with Medicare and Medicaid. Another example of mediocre healthcare delivery is with our nation’s veterans. The Veteran Administration (VA) system of healthcare is increasingly slow, impersonal and cumbersome.
Private sector delivery systems can provide an answer as long as they are regulated to eliminate unfair business practices and unscrupulous profiteering. To allow a system to become successful as a business model, it must keep overhead down, allow current advances in communication technologies to be at its disposal and become free from the blood letting of insurance companies and a legal system with no reforms to place a ceiling on monetary awards for malpractice claims. One way to solve issues of cost containment for delivery models that will allow savings to be past to consumers is the use of telehealth with self insurance and the passing of legislation for tort reform. For a mere fraction of the cost of operating a brick-and-mortar typical family practice, telehealth can accomplish almost 70% of what can be conducted in an office setting without the cost prohibitive costs. End result is the savings passed along to the patient (consumer). Making routine and basic healthcare one again affordable.
Exploring this model are several telemedicine or telehealth services. The group of clinicians I am in association with have departed from the typical means of conducting business via a traditional office based practice and is exploring new ways of healthcare delivery via telephone and video-consulting. The Internet savvy end-consumer will most likely embrace this new technology with offers great promise and practicality. Older patients who are used to office based practice may find the task of trusting the Internet and telemedicine a daunting task. The younger patient, typically will have minor acute illnesses that have lower acuity and can be managed comfortably by practitioners well versed in telemedicine, knowing the abilities and limitations of the system. Thousands of healthcare dollars can be saved if this new model is embraced. This will divert non-emergent or non-urgent patients from burdening our already overcrowded emergency departments and allow for better and more efficient management of higher acuity patients in true need of the ED.
Likewise access to online direct access testing (DAT) will allow astute consumers/patients direct access to lab and blood testing. Bypassing the traditional avenues to obtaining routine annual labs, they can once again drastically reduce their expenditures on the basic routine aspects of health and wellness. With only minor interventions and guidance by healthcare providers the vast majority of the public can obtain affordable healthcare tests they would have otherwise ignored or put off for lack of ability to pay a higher price tag. Affordable and easily accessible telehealth may very well be the panacea to save the majority of uninsured clients in our state and the nation.