Why did people get so mad at Martin Shkreli? Fueling last week’s outrage over the “ex-hedge-fund-manager” increasing the price of a life-saving HIV drug over 5,000% was an implicit concern over patient access to care. How will suffering people receive treatment if they can’t afford it? Meanwhile, access reaches far beyond economics. Socioeconomic status certainly correlates with differing health outcomes, but it’s far from the only factor. What determines access to healthcare? Let’s start with a couple basics we’ve been hearing about this week.
Where and when does healthcare happen?
If it seems a bit mundane, consider this: in the 1950s, house calls accounted for an estimated 40% of patient-doctor interactions. By 1980, that figure was 0.6%. And the “where” of healthcare is still up for debate, with so-called “telemedicine” making headlines this week as its affordability and effectiveness is scrutinized. The healthcare-at-home angle has its even-higher-tech cousin in Minnesota’s new “Well Living Lab,” which seeks to monitor and manipulate everything from window placement to sleeping positions, building health into the walls and floors. Also up for discussion this week were “workplace wellness” programs, focusing on employees health. Proponents speak of patient proactiveness and empowerment, while detractors worry about overdiagnosis and rising healthcare costs. A parallel conversation has been going on in Massachusetts (and elsewhere) over screening high school students for drugs.
Another back-to-basics healthcare item in the news has been the “when”. Early detection is nothing new, but implementing and acting upon that value has taken different forms. This week, the Times praised San Francisco for its plummeting HIV rates, sourced in the dual practices instantly providing medication to those who test positive for HIV, and providing preventative medicine to at-risk populations. Elsewhere in California, preventive care (and house calls!) are in the spotlight, with Alameda County paramedics performing follow-up visits to anyone and everyone discharged from a hospital.The focus on instant care, too, has taken center stage in the fight against heroin overdose, especially in New England, which is in the midst of an opioid epidemic. CVS announced just last month that it would make naloxone, an overdose reversal drug, prescription-free in twelve more states.
Cutting-edge research may be where the money’s at, and might have more allure for America’s prized myth of the entrepreneuring scientist, 21st-century frontiersman, but the value of healthcare in the right place, at the right time, can’t be overlooked.