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The U.S. Has the Best System of Health, and the Lowest Patient Satisfaction: What is going on?

Updated: Aug 4, 2023

This post is the first in an ongoing "CEO Article of The Week" original content series written by Integral Leaders in Health Founder and CEO, Spence Taylor, M.D. New articles on various topics related to our organization's purpose will be published each Monday.

“America has the best healthcare in the world.”

This is a popular sentiment commonly heard around the world, especially in the United States, and there is plenty of evidence to back it up. Of the four components that comprise the medical care environment doctors, hospitals, payors and universities/Innovators – our country consistently tops every other country in the rankings. Four of the top five and nine of the top 25 hospitals in the world, according to Newsweek (2021), are in America. There is not a ranking system of the world’s doctors that does not rank the U.S. number one. Three of the top five and 13 of the top 25 medical schools in the world, according to QS World University Ranking, are located here as well. And the U.S. outspends (per capita) the average world nation 2:1 in healthcare. No one comes close to paying more – it is nearly 20% of our GDP.

South Carolina is a fast growing state, and comfortably fits in the category of the world’s best given its large tertiary care hospitals, four medical schools, number of physician specialists and ample financial resources (when compared to others around the world). Most would conclude we are truly blessed.

But wait….

In a Harris poll completed earlier this year, only 27% of respondents nationwide felt that the healthcare system was meeting all their health needs.

That means that more than 70% expressed some degree of dissatisfaction with our medical care system. Nearly 50% of respondents also reported they needed help to navigate the complexities of the American health system (82% of whom reported frustration and a feeling of being totally overwhelmed in the process.). This Harris poll only scratches the surface. Last year, a Associated Press-NORC Center for Public Affairs Research poll found only 12% of respondents felt the health system met their needs. Multiple academic reports demonstrated the same thing. In fact, the evidence is quite clear:

Just as it does in all other rankings – the U.S. also leads the world rankings in health system dissatisfaction.

How can this be? We are the best providers in the world, but produce the least satisfied users?

It is this paradox that prompted us to spend the last 18 months investigating the issue, the findings of which motivated us to form a Delaware Public Benefit Corporation called Integral Leaders in Health. From our research, we made two discoveries and have drawn one conclusion. First, patient frustration with the medical care environment in South Carolina, based on countless encounters with both satisfied and dissatisfied patients, is rampant – patient well-being is no longer felt to be the priority (a subject for next time). In fact, there is evidence of an evolving Medical Care Crisis (the ‘ABCs’ shown below):

Second, while dissatisfaction prevails, the quality of the hospitals, doctors, payors and universities when examined individually seems very good. South Carolina parallels what can be found when looking at the nation as a whole.

This has led us to the following conclusion: the medical care environment—which relies on the balance of its four components to maintain patient well-being—is completely out of balance.

Over time, the well-being of the components has insidiously taken priority over the well-being of the patient. There is no other explanation. Accordingly, the answer is also quite clear. We must re-balance the medical care environment in order to restore patient confidence and well-being.

Of course, we found everyone reactively blaming everyone else: Obamacare (i.e., the payor) is the reason medicine is broken; the hospitals have gotten too big and too money conscious; the doctors are different today and do not work as hard; and The medical schools and residencies are no longer preparing doctors for the rigors of practice.

Blaming and complaining has seemingly become a national pastime.

But remember, as we have just established, the quality of the four medical environmental components is the best in the world. Our situation is not the result of a “component quality issue.” This is a medical care environment that is not working well as a team – it is an environment out of balance.

Remember the New York Yankees under the ownership of George Steinbrenner in the 1980s? They had teams where massive sums of money were spent to assemble the best talent and yet they could never win the World Series. Their team performances never exceeded (or even approached) the sum of their individual talents. Just like the current medical care environment today, they seemed out of balance.

So, what is the answer? Make the hospitals better? Find better doctors? Get rid of Obamacare? Start another medical school? Maybe.

But first we must restore balance to the current medical care environment and make patient well-being the priority. To do that requires integral, win-for-all solutions devoted to systematic change – change that can only be accomplished through integral leadership. We must make one from many for the service of all.

Said another way:

We need integral leaders in health.


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