For those seeking to better understand the US healthcare system, national healthcare consultant Dr. Jonathan Burroughs suggests playing a game of “follow the money.” He asserts that whenever healthcare appears illogical, following the money will make it all rational and clear. The U.S. spends 2x as much money as the rest of the industrialized world, yet its citizens do not live as long as they do in 36 other nations. Dr. Burroughs gives an overview on how to fix the system. Dr. Burroughs has worked with over 1,100 hospitals across the country to help healthcare leaders navigate the 21st century. He is a popular national speaker, who speaks to the impact of healthcare reform on hospitals, physicians and patients. Jonathan is a healthcare legal expert, who has participated in over 65 cases across the country. He is the winner of the James A Hamilton Award in 2016 awarded by the American College of Healthcare Executives titled “Redesign the Medical Staff Model”. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at
How To Understand U.S. Healthcare? Follow The Money | Dr. Jonathan Burroughs | TEDxWolfeboro | Only Sports And Health
In india … you earn all life and all your money is taken in just few days at hospital….Mafia is even merciful than hospitals
Sorry, but single-payer is the most affordable, efficient and health-conscious way to deliver to your citizens. The problem is a profit-driven system.
US healthcare is corrupt, immoral, and “all part of the plan”
Universal healthcare just like Europe, there you go.
I’ve been saying this for years. If something ever doesn’t make sense, just follow the money and eventually it will.
This was a well-presented talk and a good perspective on the economization of the healthcare in the United States. The healthcare system in the United States is often criticized for being too expensive and inaccessible to many Americans, raising questions about the fairness and justice of the system. One of the key factors driving the high cost of healthcare in the United States is the for-profit nature of the healthcare industry. Unlike many other countries, healthcare in the United States is a commodity, bought and sold in a market-based system. This means that healthcare providers and insurers are motivated by profit, and the cost of healthcare services is often determined by supply and demand. From an ethical perspective, this raises concerns about the commodification of healthcare. Healthcare is a fundamental human right, and the market-based approach to healthcare in the United States may undermine the principle of justice. The for-profit nature of the healthcare industry can lead to inequities in access to care, as those who can afford to pay for healthcare are more likely to receive it. This can perpetuate social and economic inequalities and contribute to a lack of fairness in the healthcare system. The high cost of healthcare in the United States can lead to significant financial burdens for individuals and families. The cost of healthcare can be prohibitively expensive, leading some individuals to forgo necessary medical treatments or delay seeking medical care until their conditions worsen. This can lead to poorer health outcomes, increased healthcare costs, or, as mentioned in this talk, earlier age of mortality. From an ethical perspective, this raises concerns about the principle of beneficence, which truly should be the driver behind anyone’s desire to work in healthcare. The high cost of healthcare can make it difficult for patients to receive the medical care they need, potentially leading to harm and suffering. This can be particularly problematic for vulnerable populations, such as those who are uninsured or underinsured. The current healthcare system also has the risk of leading to significant disparities in healthcare access and outcomes. Health outcomes in the United States are closely tied to social and economic factors, such as income, education, and race. This means that individuals who are marginalized or disadvantaged in these areas are more likely to experience poor health outcomes and limited access to healthcare. From an ethical perspective, this raises concerns about the principle of justice, which refers to the duty to treat people fairly and equitably. The current healthcare system in the United States can perpetuate social and economic inequalities and contribute to disparities in healthcare access and outcomes. This can result in unfair and unjust treatment for certain individuals and populations. The economics of healthcare in the United States raise significant ethical concerns. The for-profit nature of the healthcare industry can undermine the principles of justice and fairness, while the high cost of healthcare can lead to significant financial burdens and disparities in healthcare access and outcomes. I believe that it is essential for healthcare to be considered a fundamental human right, rather than a commodity to be bought and sold in a market-based system. This would however require a rethinking of the current healthcare system and a renewed commitment to promoting fairness, justice, and the well-being of all patients.
I understand it, a for profit scsm
The US healthcare system has been constantly criticized on its focus on return on investment and monetary practices rather than focusing patient outcomes. Naturally this approach can have significantly decreased outcomes for patients. When healthcare providers prioritize monetary policies, they often times are more likely to focus on treatments and procedures that result in higher profits, rather than treatments that are more cost effective for the patient. Thus, this can cause overutilization of certain treatments, as well as underutilization of potential uses of preventative care, which all lead to poorer outcomes for patients. This overwhelming focus on ROI can lead to disparities in healthcare access. Providers may prioritize only accepting and treating patients who can afford such treatment and declining to bring on patients who cannot. Practices as such can affect health outcomes for marginalized communities. Moreover, these communities already face barriers accessing adequate healthcare. The United States Healthcare system should begin to prioritize the well-being of patient’s over financial status. This will require a shift towards a more patient-centered approach. Healthcare providers will have to become incentivized to provide quality care that meets the needs of their patients, rather than just focusing on pure profits. One such approach to start this shift is through greater regulation of healthcare pricing and reimbursement. This method will help to reduce the financial incentives for physicians to prioritize patient outcomes over financial gain. Another example to help with this disparity is to increase investment in preventative care and public health initiatives to help reduce the need for expensive treatments and procedures in the first place. The focus on monetary practices in our US healthcare system naturally has negative impacts on healthcare. including disparities to healthcare access and decreased health outcomes for patients. By shifting towards a more patient-centered approach, physicians and hospital administration alike can work towards ensuring healthcare is accessible, affordable, and effective for all individuals, regardless of what their financial status is.
Dr. Burroughs raises a great point about the American healthcare system in its current state. I never thought about it from his perspective, but it is clear to see that procedures are incentivized over well visits and keeping patients out of the hospital. From an ethical perspective, this screams maleficence from a systemic level. Studying to be a physician myself, I have heard countless recommendations from loved ones, random people passing by, and peers about why they would prefer to specialize over going into a lesser-paying job such as family medicine. After connecting the dots, the real issue here is trying to approach the healthcare financial system to improve patient outcomes and incentivize these results in addition to the complicated and life-saving procedures that various surgeons provide on a daily basis. A for-profit system may benefit some but not the entirety of the American population, and for that reason it could be considered unjust from a medical ethical perspective. From my own perspective, I recently turned 26 and learned very quickly about how expensive certain visits can cost out of pocket when you are not expecting them, as I recovered from a sinus infection and had to recover financially at the same time. Return on investment should not be the primary focus in healthcare, a system that ought to be held to the highest ethical standard and provide the best and most affordable care to the patient.
Went to doctor with my thyroid issues, rash ,heart pain,fatigue and radiation side effect.He was deaf but able to say you need a memmogram and colonoscopy
This was a highly informative discussion on the backstory of the economics of healthcare in the United States. I think it is interesting that the United States has created a healthcare system that, at its core, seeks to meet business expectations and success parameters rather than markers of efficient, high quality, and affordable healthcare. I think the impact that this has on our healthcare system is catastrophic and threatens the very basic ethical principles of medicine. At the core of clinical medicine, medical physicians are tethered to the ethical principle to do no harm and that principle should extend to all individuals involved in healthcare and all levels of the healthcare system.
After listening to this discussion, I wonder why hospital administration, shareholders, and other employees of the business model are not also held to this standard. I don’t know that healthcare in the United States will be able to exist without some business model but based on this speech, there is a balance that can be achieved. Unfortunately the medical system, starting with the abysmal price of medical education, has created a system that both has to and wants to value money. It is not difficult to understand or see where and why such greed abounds when there is an extensive amount of capital to be made. However, the principle of do no harm should extend beyond the boundaries of just clinical medical care and permeate all aspects of the medical model. It is difficult to hear that medical care is the main reason for bankruptcy in the United States. As a current medical student, I think about how every test I will order one day or test I may run will clarify the potential diagnosis and hopefully more rapidly get the patient back to a state of optimal health. However, it will simultaneously be filling the pockets of a company or individual who is essentially profiting from another individual's suffering and disease. Furthermore, once that patient leaves the hospital or clinic, they may be back to a state of “optimal” health, but the financial expense incurred from that experience may soon leave them financially broken and perhaps in a worse place than when they started. It is not difficult to see that providing high quality clinical medicine is only one-half of the do no harm imperative, if a patient goes home and is then forced into bankruptcy because of care that we provided them, how can we collectively as a medical profession claim that we did “no harm.”
I completely agree with Dr. Burroughs’s viewpoint that healthcare in the United States has, unfortunately, begun to focus more on monetary rewards as opposed to patient health. Personally, I think the issue most often lies within the large corporations employing physicians. Since they are businesses, all they care about is making money. Therefore, they encourage anything that brings the hospital or clinic more money, even if that means pushing their physicians to compromise their ethical obligations to their patients. For example, I previously worked in a clinic that was constantly pushing its providers to see more patients each day even though every provider was already seeing 30-40 patients per eight-hour shift. This obviously led to frustrated patients due to poor patient care and minimal interaction with their physicians. We even had one provider who started instructing her medical assistants to knock on the door with an excuse for her to leave the room if she was in one patient’s room for too long. This provider did not employ this strategy because she didn’t want to spend time with her patients but because if she spent more than ten minutes with a patient then she would be running late to see every other patient for the rest of the day. The other issue that can arise from providers being pressured to cram so many patients into their schedule is they must delegate more tasks to others. This is okay if the provider is confident that they have competent medical staff, but if they delegate a task to someone who does not know exactly how to perform it, they run the risk of causing harm to the patient. Overall, it is frustrating to see our medical system structured more toward making money than patient care. Not only is it frustrating for patients due to the rising prices of healthcare with increasingly poor care, but it is also forcing providers to compromise their ethical obligations to prevent harm and promote good for their patients. Additionally, in some cases, providers may risk inflicting harm on patients if they neglect to properly oversee the actions of their medical staff due to time constraints. Every physician goes into medicine with the intent of helping people, so it is a shame that our healthcare system does not equally reflect that value. Hopefully, in the future, we can work toward getting our medical system to focus less on monetary rewards and more on the health of its patients.
I believe Dr. Jonathan Burroughs makes an excellent point regarding the financial status of healthcare in the United States. We are continuing to pay for sickness, procedures, and surgeries, and neglecting some of the most fundamental specialties in medicine. Primary care physicians and pediatricians are some of the lowest paying physicians, but some of the most crucial ones necessary for good health. Due to the rising costs of medical education, many students are opting to go into higher paying specialties, just to pay off the debt accumulated throughout school and residency. We are seeing less general family doctors and more highly specialized physicians, and the money reflects that. The question that comes into play is how many of these procedures and surgeries are absolutely necessary, and how many are being performed for the money? The concept of beneficence is the duty of a physician to do what is in the best interest for the patient. If we start adding financial compensation into the play, the guidelines of what is considered ‘good’ for the patient might be stretched. How can we ensure that surgeons are performing surgeries that are in the best interest for the patient, and not just so that they have a few extra zeros at the end of their paychecks? If money continues to be prioritized over what is best for the patients, the trust between a doctor and patient might be lost. It is disheartening to see something as valuable as healthcare be so highly monetized. Bankruptcy due to medical bills is another huge consequence from placing so much value and emphasis on money. A one-night stay in the hospital is not something every individual can afford, let alone all the additional labs, imaging, and procedures required during admission. How can we make a decision regarding a patient’s best interest, if it will potentially bankrupt them? Patients will continue to actively avoid receiving care just because they cannot afford it, until the economics of healthcare is further investigated.
As Dr. Burroughs pointed out during this talk, the healthcare system in the United States has a large monetary focus compared to the rest of the industrialized world. Being a medical student in the in the United States you hear a lot of other students when discussing their medical specialty of interest mention the average income of individuals working in that specialty. Many are deterred by specialties like family practice and pediatrics because they are some of the lowest paid providers but instead want to work in higher paid specialties like orthopedic surgery or plastic surgery. This also brings up the fact that many of these higher paid specialties that involve surgery could be high because of a push for elective surgeries since the more surgeries a doctor does, the more they get paid. I think some people lose sight of what the medical field is truly about, taking care of the greater population. However, it can be understandable as the cost of medical school rises to the point where doctors that graduate from medical school are usually hundreds of thousands of dollars in debt and then have to work another 4+ years getting paid essentially minimum wage due to the long hours that are required of resident physicians. This vicious monetary cycle makes upholding the ethical tenets of medicine extremely difficult. For example, as Dr. Burroughs mentioned, receiving the proper healthcare can be extremely expensive especially for things like cancer treatment which can alone bankrupt a family. This violates the principle of justice which is supposed to ensure every individual can receive the same care no matter what. If someone is unable to afford the treatment they need and suffer because of it, this is unjust.
I thought the point Dr. Burrough made about the standardization of healthcare was extremely interesting. In medical school we are all taught the same protocols to follow for various conditions and diseases, however this may vary by school. We are then taught more applicable treatment processes when we go on rotations as compared to what is technically stated in textbooks. This is where more variation can happen since the way one doctor treats an upper respiratory infection or cystic fibrosis may be different than another even in the same hospital. These variations may cause significantly different outcomes as Dr. Burrough mentioned the 30 year difference in life expectancy of patients being treated for cystic fibrosis at different hospitals however, the problem arises with how that information can be delivered to doctors. I believe there is a lack of communication or sometimes initiative of physicians to continue to research new protocols or treatment regimes for the diseases they treat. This leads to a disparity of treatment and thus the patients inevitably suffer because of this which violates the principles of beneficence since they may not be getting the best treatment possible for their condition.
Was interesting to hear that 40% of Americans die in hospitals each year. Could use a rephrasing lol
it's more beyond the transactional relationship with financial ROI… but of course it is a large part of the equation. There are a lot of improvement spots. I am not a big fan of cynicism… there are so many very learned people involved in these very important issues.
The reality of tech and methodology… relationship and rights of people, providers and systems/communities.
interoperable
the connecttions with community… its not one size fits all… it's just not… but lots of better
good ides to incorporate in chaange management and medical eco systms
Every aspect of US healthcare is hopelessly corrupt…including the doctors and nurses.
OMG! The answers are there to improving outcomes for patients but it will require a major shift in priorities and killing off the fear from the propaganda machine about socialism. I cried when Dr. Burroughs said about the about the life expectancy difference for patients with Cystic Fibrosis depending on level of medical care. Those sort of horrible variations in CARE should not happen anywhere but is horrific that it can happen in a country where treatment should be the best in the world.
Please can someone tell me if there are there any independent organisations in the USA that patients can access to find doctors (and other professionals) whose treatment programs ensure best practice evidence-based care?
Here in Australia, we have the Australian Health Practitioner Regulation Agency (AHPRA), which is a government agency that oversees 15 national health practitioner boards including: – Chinese medicine, chiropractic, dental, medical, nursing and midwifery, occupational therapy, osteopathy, pharmacy, physiotherapy and podiatry. AHPRA ensures that registered health practitioners are suitably trained, qualified and safe to practice. They also respond to patient complaints and give patients information about expected standards of care and provide access to practitioner registration lists. As a nurse/midwife it was mandatory for me to complete 40 hours a year on Continuing Professional Development (CPD's) with most of these hours spent learning the latest Evidence Based Best Practices. Nurses must complete 20 hours, a nurse/midwife must complete 40 hours and a medical practitioner must complete 50 hours of CPD hours per year before being approved by AHPRA for reregistration. We also must keep a record of hours for five years, as our CPD hours may be audited.
I didn't hear a solution. All I heard was how poorly doctors are diagnosing health problems. There's no such thing as competition driving down costs. The other problem is, how do you "shop around" when you need emergency care or you need a procedure? Where so people go who can't afford insurance?
Yes this is all known and yet no one does anything about it!?!?
GREED happened!
My wife already told me that she would make certain that I die at home.
I'm 75 and 5 years after this talk. Nothing has changed. Nothing will change even if I live to be 90 years old. I will outlive my savings and get very poor health care in my final years. One thing I want is for Americans to be eligible for Medicare at age 70, Social Security, too. I've found that most people in their sixties are quite able to work and remain reasonably healthy. Most of all I want universal health care, Medicare for all. No more Medicaid or all these separate programs to piecemeal coverage. What to do about politician bribery I have no clue; it's the key to any change at all.