Publisher's note: This post appears here courtesy of the Carolina Journal, and written by Jordan Roberts.
What comes to mind when you think of the term "health care delivery?" Most people probably think of entities like doctors' offices, insurers, hospitals, and pharmacies. These are the most common ways in which people access the health care system, as this has been the status quo in health care for some time. But health care delivery is changing, and regulations often stand in the way.
In any given sector of the American economy, there will be natural innovations that stoke hesitation and fear in people's minds. We have seen examples of this throughout history - trains, the telephone, TV, and the internet all scared people upon their creation. Now they're engrained in our lives. I see some similarities in the way innovators are changing health care now. Skeptics may be hindering innovation with an insistence on regulation.
Consider telemedicine. If you told someone from the year 2000 they would be able to access a doctor for diagnosis and treatment through a video conference on a smartphone, they probably couldn't imagine this. But now this is more common, and telemedicine usage is on the rise. A 2018 report in JAMA
found telemedicine visits grew by 52% annually from 2005 to 2014, and increased by 261% from 2015 to 2017. Some are skeptical of this practice, but telemedicine has the potential to supplement the traditional delivery of care by connecting patients to physicians all around the country in real-time. Yet telemedicine licensing laws restrict a patient from only seeing a physician who's licensed in their state. Knocking down the artificial state barriers to accessing physicians through telemedicine will bolster access for patients across the country.
Primary care is another area in which the delivery of health care is changing. America suffers from declining numbers of physicians who choose to enter primary care. Furthermore, many Americans live in a medical desert, where there aren't enough primary care doctors. Nurse practitioners are helping fill this void. According to a recently published study in Health Affairs
, the nurse practitioner workforce grew from 91,000 in 2010, to 190,000 in 2017. Yet 12 states, including North Carolina, impose strict supervisory requirements on how a nurse practitioner can practice. Freeing nurse practitioners and other advanced practice registered nurses from these unnecessary regulations would grant them the opportunity to practice where they want, including in more rural areas that desperately need extra personnel.
Another example of where health delivery is changing is the rise in outpatient surgery centers. Traditionally, any major procedure that could not be performed in a primary care setting would have to be done in a hospital. Hospitals have become some of the most expensive facilities to receive care. Given this trend and advances in medicine, many surgeries that could traditionally have required an inpatient stay can be done in a much cheaper outpatient facility, such as an ambulatory surgery center. These facilities have grown in number in recent years. According to a report from industry group Bain and Co., ASCs performed more than half of all outpatient surgeries in 2017, up from just 32% in 2005. Furthermore, research shows the ASC market will grow 6% to 7% annually through 2021. However, many states, like North Carolina, still require permission from the government to build a new ASC through the certificate of need programs. Removing these requirements on ASCs will give patients, and insurers, access to much lower cost surgery centers.
The point of this is to say health care regulations may be harming natural medical innovation. Just like in other sectors of the economy, innovators are creating new ways to meet demand. But this isn't innovation for innovation sake. These are attempts by private actors to solve complex problems within our health care system that can drastically lower costs, extend access, and improve health. But these innovators are often hamstrung in how they can practice medicine because of restrictive regulations.
There are severe shortfalls in the current structure of the American health care system that makes it expensive and difficult to use. Allowing private innovators, free from burdensome regulations, to create new solutions in the American health care system will be the way to a better future.