How to Save American Healthcare

The future of U.S. healthcare is cheap, small, and at home.

The American healthcare system is the most expensive in the world, with some $2.8 trillionor one sixth of the economys outgoingsracked up in spending per year. Its a structure that describes endless criticisms for its inflated drug costs, regular additional charges on top of insurance premiums, and appointment wait times that rank among the longest of the leading industrial nations.

Welcome to the age of bite-sized, megabucks-saving medicine .

A new wave of tests and technologies, however, is slowly is carrying out the kind of developments the countrys health industry has long been calling out for. Labs on microchips, home-administered HIV kits, hypertension tracking smartphone apps; these new innovations are proof that the medical scenery is capable of change, and that the 30 million uninsured Americans, and tens of millions of citizens with inadequate coverage, could face a different, better, future.

Welcome to the age of bite-sized, megabucks-saving medicine.

When it comes to shrinking down the costs and expanding the benefits of health tests, Martin Yarmush, Distinguished Professor of Biomedical Engineering at Rutgers University, is leading the charge. The so-called laboratory on a chipa breakthrough device that vastly reduces the price of disease biomarker analysis by use 90 percentage less liquid samples than tests usually requirewas created after his squad found they had a specific need that could not be addressed with current technology.

By use miniaturized valves and channels in place of the usual benchtop-sized assays( or procedures ), which need much larger blood or liquid samples that are then mixed with expensive chemicals by laboratory personnels, the price of carrying out tests for the likes of syphilis and Lyme Disease was dramatically reduced not only in terms of the materials, but by automating much of the labor commonly required.

The results are as sensitive and accurate as the standard benchtop assay, Dr. Yarmush says.

The size of the sample is important not only in driving down the costs of tests, but in widening its scope of application, too. The inability to extract enough liquid from certain animal models in order to perform accurate and comprehensive testing has long proved to be a barrier to further discovery, but by being able to correctly analyze far smaller quantities, the lab on a chip could open the gateway to testing for many more biological samples of limited volume.

Any diagnostic procedure that can provide the same answers at a lower cost will have an impact, Dr. Yarmush adds. This is a very active field and examiners will continue to innovate in this space.

One of the biggest innovations in medical care has been how much of it can now be administered by patients themselves. Changes in the legislation surrounding HIV testing contribute to a raft of in-home tests being created worldwide, enabling potential sufferers to undergo the procedure without the stigma going to a hospital for diagnosis can bring.

We are ensure a trend towards more self-administered care, due to many factors, including rising healthcare expenses, access to more information on health conditions and therapies, and the advancement of certain technologies that enable consumers to be able to accurately perform the tests at home, says Ron Ticho, senior vice president of communications at OraSure, the company behind Americas first home HIV kit.

Any technology that enables a person to learn their HIV status, whether at a clinic or at home, will help them build more informed decisions about their own health, and hopefully will enable them to seek and find the follow up care that they need to live a longer and healthier life, says Ticho.

More than 1.2 million people are currently living with HIV in America, while virtually one in eight of those are unaware that they are infected. Late diagnosis means sufferers have a far greater likelihood of succumbing within the first year of testing positive, constructing the convenience of a test like OraQuicks all the more vital.

I think its a fantastic idea, says Steven Irving MD, an emergency physician resident in Detroit, MI. This test has great potential if these restrictions are understood by the public and there is a support system in place with appropriate resources if the test is positive.

But he notes that there are some important caveats. Diagnosing HIV is not as simple as a drop-off of blood: its a two-step process, he explains. The first is an ELISA, the antibody test, then a confirmatory testthe Western blot testis used. At our Emergency department, we have a squad that specifically focuses on assistance when a positive HIV test is performed: they help explain the limitations of the test, set up further appointments, and counsel on the next steps.

Newer generation tests could lead to people expressed his belief that “they il be” HIV negative two weeks after a one night stand, and[ allow them to] continue to spread the disease without knowing they are infected, Irving explains.

This is a sense of caution shared by many healthcare professionals, who are concerned that the easy to use, quick to find nature of new medical technologies will lead patients to believe their own health issues can be entirely resolved at the click of a button. With the mobile health app market estimated to be worth $ 20.7 by 2018, its big business for potential investors, whose targets arent just limited to patient welfare.

Apps like Blood Pressure Monitor, which purports to measure your heart rate, depression diagnostic MoodTools and SkinVision, which assesses whether your mole is malignant, offer high risk, high reward alternatives to those willing to trade wait rooms for the app store, but tellingly, in a study of 100 apps promising to quash hypertension, researchers found that there was no correlation between ratings and efficacy. Those that pledged to measure a users blood pressure through the phone itself( which cannot be done accurately) ensure millions of downloads and five superstar reviews, in spite of their inability to deliver.

The tech industry can be very quixotic in its innovation-seeking desire to try to deliver things faster, quicker and more efficiently, says Jonathan Lee, a Fellow in International Emergency Medicine at Columbia University Medical Center, but efficiency isnt always the best thing in healthcare and clinical medicine.

That criticism certainly rings true in the light of the recent controversy surrounding Theranosa company offering a cut price blood test that required just a thumb pricks worth of liquid and several hours to deliver the same results as the standard procedure( which usually involves several vials of blood to be taken and days or weeks for processing at a laboratory ).

At a cost of half of the current reimbursement rates for Medicare and Medicaid, Theranos seemed set to cause major disruption to the $75 billion-a-year blood testing industry. But an investigation by the Wall Street Journal found that the mysterious machines being employed to carry out this super fast analysis werent being used at all, and that the blood samples were in fact being collected in the usual route and then diluted for use on other, older tools from companies like Siemens.

Theranos Edison machines were also found to be significantly less accurate than claimed, with the companys former employees complaining to regulators about their lack of precision, and users coming forward to reveal that the results of their $5.35 test did not match up to those administered the old-fashioned way.

To that end, Dr. Lee questions whether self-administered care really saves patients the time and money they believe it will. Do you suppose you could take your results to the hospital and say here, take my term for it? No. The physician will test and confirm it with their own tests. Why do it at home when any clinic or hospital will do the same for you?

Perhaps the field of high-speed diagnosis isnt quite as groundbreaking as their in-laboratory equivalents, then, but the advancements being made in instituting low-cost medical alternatives could not have come at a more prescient hour. News of the 5, 500 percentage price hike of Daraprim, a pill designed to treat parasitic infection toxoplasmosis, hit the headlines in September, forcing Americas absurd drug pricing statutes into the spotlight.

As the only country which permits private companies to decide the cost of the pills they manufacture, leading to an estimated average gain margin of 21.6 percentage( the industry median is closer to 15 percentage ), the current practice of physicians over-prescribing overpriced pills for patients is severely in need of reform.

Now, more than ever, this current upsurge in affordable medical upkeep could demonstrate lifesaving.

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