Medical schools fail to teach students about the health care system

Any health care provider can tell you that clinical knowledge isn’t the only thing that determines how well you care for your patients.  We’ve all seen — many times — the patient that can’t afford the correct antibiotic, doesn’t get preauthorization for the necessary CT scan, and can’t find a specialist who will take his or her insurance.  Making the correct diagnosis is only the first step in helping a patient, and many of the roadblocks that we encounter are related to health care policy, delivery and economics.  Knowing how to navigate the health care system leads to better health outcomes for patients.

Unfortunately, few medical schools provide effective teaching on the health care system to their students.  Recent surveys have shown that 90 percent of medical students want increased exposure to health systems materials during medical school, and, surprisingly, 60 percent of medical school deans agreed that their schools have “too little health policy education.” Finding space in an already-packed curriculum is tough, but I think it’s important to recognize the importance of health systems.  To cite just one study, “Lack of health insurance is associated with as many as 44,789 deaths per year in the United States, more than those caused by kidney disease.” Think of the hundreds of hours that medical students devote to studying the kidney and kidney disease, and contrast that with the dozens of minutes that most schools spend on health insurance.

Not surprisingly, medical students are lacking in their knowledge of health policy, delivery and economics.  One recent student found that most medical students have significant deficiencies in their knowledge about the health care system, and that fourth year students performed no better than first year students. I recall feeling very embarrassed as a medical student when patients had questions about costs, insurance and access that I could not answer.  Even worse, the residents and attendings knew scarcely more than I did, and a surprising amount of their knowledge was based on incorrect hearsay and anecdotes.

The U.S. health care system is changing rapidly, and so is the way that we provide care to patients — and make a living.  Patients are looking to health care providers to help them navigate the confusing world of HMOs, PPOs, ACOs, and PCMHs, along with their COPD and CHF.  Not every physician needs to become a health systems expert, but all providers should have a fundamental level of knowledge that can be shared with patients, and should direct patients to other resources for questions that are too complex.

For too long, physicians have abdicated responsibility for the health care system to business people, politicians and other professionals that don’t have experience caring for patients, and often do not have patients’ best interests at heart.  Issues dealing with the health care system lead to worse health outcomes for patients. To change the system for the better, providers must first know how the system works. That’s why every medical school should make health policy, economics and delivery a key part of their curriculum.

Nathan Moore is an internal medicine resident and co-author of the Health Care Handbook: A Clear and Concise Guide to the United States Health Care System.

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