Why Is Our Healthcare System Crazy? Monty Python Knows

Greg A. Hood, MD

Disclosures

July 27, 2016

In This Article

Searching for Answers, Across the Pond

The entire world is discussing Brexit, which is shorthand for Britain's exit from the European Union. Some are asking how Brexit 2016 (actually, Brexit 2.0) might reflect upon or influence politics, elections, and life in the United States (the home of the original Brexit, of 1776).

Healthcare (the National Health Service [NHS], specifically) was a central issue in the Brexit debate. Citizens of the United Kingdom love the NHS but have significant concerns about how it performs presently and about its future. So prominent is the NHS in the culture and minds of the United Kingdom's citizens that the NHS was highlighted in the London Olympics opening ceremonies, alongside such paragons of British culture as Monty Python and the Who.

Traditionally, America's culture, business practices, laws, and politics have been influenced by the United Kingdom. However, if you look at healthcare in the United States, you might wonder whether Monty Python and Douglas Adams, author of The Hitchhiker's Guide to the Galaxy, hadn't already inspired the creation of US health policy. As Adams once cautioned, "There is a theory which states that if ever anybody discovers exactly what the Universe is for and why it is here, it will instantly disappear and be replaced by something even more bizarre and inexplicable. There is another theory which states that this has already happened."

In some regards, the universe of US healthcare may have already experienced this. A prime example is how some insurers are subverting the annual wellness visit (AWV).

Although patients who skip their annual visit seem to perceive it as something akin to what appears in the Python sketch titled "Ministry of Silly Walks," these visits are an important means of providing people with continuity of care. This emphasis on preventive screening and services allows another touchpoint for patients with the practice that serves as their medical home. The AWV allows beneficiaries to receive additional screenings, chart reviews, and attention that previously were difficult to coordinate in busy primary care offices.

In addition, because there's no charge to the patient for these services, he or she will typically pay less for their care overall than they would have paid to receive the same services before the initiation of AWVs. This is important for our country, because the Centers for Disease Control and Prevention has estimated that before this initiative, only about one third of Medicare-eligible women and roughly 40% of Medicare-eligible men were up to date with all age-specific recommendations for preventive services.

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