Healthcare Accessibility: A Look At The Numbers

At TEDMED this year, we will hear from three Speakers and Innovators who approach health care through the lens of economics. Through their work, we will explore different ways to think about allocating our finite resources in a world of limitless possibilities.

A natural experiment is an observational study that allows for the random—or seemingly random—assignment of study subjects to different groups. These kinds of experiments are rare but important when studying ideas that are impossible or unethical to recreate in the setting of a controlled experiment. Former Emergency Department social worker-turned-Medicaid researcher Heidi Allen seized the opportunity to study one such organic experiment in 2008, when the state of Oregon decided to expand its Medicaid program. There were 90,000 people who signed up for the expanded program, but as a result of limited funding, only 10,000 people were chosen to participate by random lottery. This unique circumstance provided Heidi and her team of researchers a randomized controlled trial with which to study the effects of Medicaid coverage.

The experiment’s results were complicated in terms of their impact on the newly-covered patients. Some outcomes were clearly positive—such as patients experiencing declining rates of clinical depression and financial stress as their medical debts decreased. Other results were less desirable. For instance, data indicated that the newly covered patients’ physical health markers—such as blood pressure, cholesterol, and cardiovascular disease—did not significantly improve. Along with these results, valuable lessons were learned. Heidi’s landmark research helped uncover truths about the role that health insurance plays in the lives of low-income Americans with limited access to coverage.

Even for people with health insurance, trying to understand or predict the costs that will accompany health care can become overwhelming. Often, it’s impossible to ascertain the cost of medical procedures in advance, and it’s not unusual for surprise bills to arrive months after your appointment. Eligible co-founder and CEO Katelyn Gleason wants to take the mystery out of medical billing. By integrating with existing medical systems, Eligible offers patients up-front information on the price of their procedures and co-pays, allowing them to pay at the time of service instead of waiting for months to receive a bill. Eligible not only benefits patients, but also physicians—who are saving valuable time not having to track down patients’ payments, helping them to collect up to 700% more revenue at the time of service.

While Katelyn is helping patients and providers demystify health care billing, health policy expert Amitabh Chandra is focusing on the important role that precision medicine will play in the future of drug pricing. Amitabh encourages us to consider the economic choices necessary to fund the next generation of medicine, in which the creation of targeted therapies that apply to smaller groups of people will change the economics of pharmaceuticals as we know it.

Funding and research in precision medicine are booming and for good reason: this approach hopes to maximize efficiency when treating disease. Currently, the Orphan Drug Act and other FDA regulatory incentives provide economic impetus for pharmaceutical companies to pursue precision medicine research. Yet it’s important to recognize that smaller markets, less competition, high technological manufacturing costs, and increased effectiveness could all result in eventual rising drug prices. Amitabh explores how we can incentivize companies to continue making precision therapeutics that patients can actually afford.

We are excited to hear more from each of these TEDMED Speakers and Innovators about their work investigating ways we can maximize our resources in economically sustainable ways. Join us at TEDMED this year to get to know them and their work better.

Indigenous economic health: Q&A with Rebecca Adamson

On the TEDMED 2014 stage, Indigenous economist Rebecca Adamson, founder of the First Nations Development Institute and First Peoples Worldwide and a globally recognized advocate for the rights of Indigenous Peoples, shares how culturally appropriate, values-driven, sustainable development based on indigenous principles contributes to a new concept of health. We caught up with her to learn more.

What motivated you to speak at TEDMED?

Understanding health as an emergent property, and seeing the individual’s health as merely a part of society’s collective health, aligns closely with the holistic approach found within Indigenous Peoples’ worldview. This understanding provided me a natural bridge to make the case that the old medical paradigm that has operated until now with a single, limited, linear worldview needed rethinking. I wanted to show how much the Indigenous worldview has been literally and figuratively handcuffed and prohibited from use. Albert Einstein once said, “You can’t solve a problem with the same conscience that created it.”  I wanted to present how culturally diverse perspectives, especially Indigenous perspectives that emphasize the health of the community rather than the health of the individual, are compelling and relevant technologies for today.

Medical science has determined that healthy individuals emerge from a healthy relationship with a healthy society in a healthy ecosystem. This means that the distribution and delivery of healthcare must meet the needs of the whole society, not merely a part of it. For me, this is a game-changer. As a Cherokee Economist, with a lifetime invested in Indigenous development, my experience with western models has been that they focus on accumulation with little attention to distribution. One of the most crucial aspects of the emergent property of health is that well-being is achieved collectively, meaning that the distribution and delivery of our healthcare actually determines the efficacy of our medical system, our individual health, and the well-being of our society. I believe the Indigenous paradigm lends a new perspective in rethinking healthcare and the medical profession.

Rebecca Adamson at TEDMED 2014

“One of the most crucial aspects of the emergent property of health is that well-being is achieved collectively, meaning that the distribution and delivery of our healthcare actually determines the efficacy of our medical system, our individual health, and the well-being of our society.” Rebecca Adamson at TEDMED 2014

Why does this talk matter now?

Indigenous Peoples are still being handcuffed, figuratively and literally. We are being arrested, shot at and killed for our natural resources. This is going on at the same time that many of our sciences (not just medical) are uncovering the interconnectivity of life – all Life. Holistic worldviews are not exclusive to Indigenous Peoples but the millennia of empirical data on how societies can organize politically, socially and economically for sustainability is being lost. Right now there is an overemphasis on the technological and financial aspects of our society. As medical practitioners, you can really see it in the healthcare system. For example, if we know that health is an emergent property then why is so little or no attention given to the distribution and delivery of healthcare for all – not merely a portion – of society? Sure, we need technology and sure, we need to pay for it – but I wanted to challenge my audience to consider a new way of thinking about healthcare and medicine, one that encompasses society as a whole. Remember the distribution of the whale hunt in an Inuit village, compared to the distribution of cash in the same village? Could you imagine our society if healthcare were to be distributed with the same sophistication as the Inuit whale harvest?  However, if we were to map the distribution of healthcare services in our society today, I fear that it would follow the pattern of hierarchical cash distribution, as opposed to holistic asset or resource distribution, where everyone is accounted for.

The efficacy of traditional medicines is just one part of what Indigenous Peoples can offer the field of medicine. Because the Indigenous worldview is holistic, Indigenous Peoples are brilliant systems thinkers. Indigenous systems leverage and account for the inter- and inner-connections between individuals, community, society and even the ecosystem. Today, we are at a critical point of opportunity where changing the distribution of healthcare is imperative for changing the health and wellbeing of our society. An Indigenous paradigm that values the interconnectedness and interdependence of society can serve as a crucial guide in shifting emphasis from financial gain to collective well-being in the medical field.

What impact do you hope the talk will have?

Our healthcare system today is riddled with problems, that I see stemming from an exaggerated focus on the individual and neglect of the collective wellbeing. I hope my talk will lead TEDMED to focus on the importance of access, distribution and healthcare delivery with the same attention that it dedicates to technology, data and finance. The answers lie in alternative ways of understanding healthcare and medicine. TEDMED has a commitment to diversity that it demonstrated in this incredible gathering of experts, both in speakers and in the audience. I challenge you all to do more. Take the mental handcuffs off. Challenge paradigms that prevent diverse voices and perspectives, as they are the only way we are going to solve the complex issues facing us today. An Indigenous way of thought accounts for the collective – an individual is just one part of a community, just as a plant is one piece of an ecosystem. In the Indigenous paradigm, the health of the individual is dependent on the health of the community. I hope my talk inspires those in medicine to begin rethinking how they approach health care, and to begin considering how our current system can reach society as a whole rather than merely a part.

Please share anything else you wish you could have included in your talk.

Ultimately, I wanted to leave the audience with this question: what do Indigenous Peoples have to share with TEDMED? Remember the distribution of the whale hunt – isn’t that, at its very best, the kind of distribution you would wish for today’s health delivery system? Can you imagine the preventative savings in a health system that reaches everyone? In a society where everyone is someone else’s mother, father, brother, sister, uncle, aunt, cousin… It is the entire society, not merely a part of it, that must survive.

What are some actions viewers can take in support of this cause?

In my talk, I challenged the audience to begin thinking about healthcare from an Indigenous perspective. Now, I challenge them to start working from that perspective – begin exploring how to make healthcare delivery reach the furthermost places in our society; how to begin emphasizing the health of the community over the health of the individual; and how to distribute medicine and healthcare so that it resembles the whale distribution map, and not the cash distribution map. I challenge medical professionals to imagine a society of collective prosperity and health, and to begin a collective discussion on how to achieve that dream.