If you're confused by our health care system, you're not alone. A five−year survey of graduating medical students says that half of them don't understand the system either.
This is what it's come to: the system has grown so complicated that even doctors don't understand it.
The national survey was conducted by the University of Michigan Medical School. It ran from 2003 to 2007 and included over 58,000 graduating medical students. Part of the study dealt with the students' perceptions: how well did their training prepare them to start a career as a doctor? An overwhelming majority were confident about their clinical training.
When it came to navigating the nation's health care system, from 40-50% of these newly minted doctors felt inadequately prepared. This lack of confidence extended to issues such as health economics, managed care.
The survey also found that a partial solution to this problem was to adjust the medical school curriculum to include more training on health care systems. The attitudes of graduates of two top−ranked medical schools were compared; one school had an intensive program on health care systems. Graduates from the high intensity program were three times more likely to report feeling adequately trained in health care systems. Though time spent on this necessarily replaced time spent on traditional medical training, it did not lower the students' confidence in their normal medical training. Seemingly a win−win situation.
Here's a bit of opinion: This type of course adjustment may be necessary at the moment. If doctors can't understand how to navigate the health care system, who can help patients? But it's worth considering whether the study results are pointing out a fundamental flaw in the system for which academic adjustments can only serve as a band−aid.
Systems don't get this complicated on their own. There's always someone who benefits from the complexity. The time−tested way to tell who benefits is to follow the money. Judging from some of the heated reactions being heard this year, neither patients nor doctors feel that they're the ones benefiting.
Any meaningful discussion of how to simplify and improve the health care system must first address the question of what health care should be: a right, a privilege or a commodity. Each answer leads to entirely different solutions. Right now, health care is a commodity: The Michigan study shows that even medical schools now feel compelled to teach the intricacies of how it's bought, sold and traded. And medical students feel a need to learn them.
Congress is currently working on a health care bill that's expected to come in at about 2,000 pages. It will require a few forests worth of paper to print copies of and will be longer than War and Peace, Les Miserables or even the unedited version of The Stand. It will certainly be interesting to see if such a lengthy document can simplify the health care system.
What is the future of health care in the U.S.? Will it be a right, a privilege or remain a commodity?
An article on the survey of graduating medical students was published in the September 2009 issue of the journal Academic Medicine.