How do we get U.S. health care system to work for patients?

The European Health Insurance Card provides care across borders for residents of many European nations. Credit: ehic.org

My husband and I were in Amsterdam a few weeks ago for King’s Day, which honors the birthday of the king of the Netherlands. But it wasn’t just a party for us.

I learned that the Dutch and much of Europe have a high rate of COVID vaccination with the bivalent booster. The citizens seem to have a different view of the vaccine, although some of the credit may go to the national health care systems in European countries that provide access to all.

I have some experience with the European system. When I was in Italy a few years ago for an AIDS conference, I fractured my ankle.

I was sent to a public hospital, which got me in and out in less than two hours. It was clean and efficient. It wasn’t fancy. But they did a great job and I got what I needed. I also was not charged.

When I was ready to fly home, I had to be certified that I was able to fly, and I was referred to a private hospital.  We went to the Rome American Hospital, which was on a palm-tree lined street and a little fancier. I was in and out in an hour and total cost to me was $150.

I started thinking about how we need to simplify our system and make it work better for patients when I got a call from a friend shortly after coming home. My caller said a friend of his, a young man, was recently diagnosed with HIV and wanted to start treatment. He had called another place in town but was told he couldn’t get an appointment for almost two weeks.

We know that starting HIV treatment early brings the best results. Yet this young man, ready for treatment, was facing delays.

I made a call to a colleague at Trillium Health, and she said she could see the young man that afternoon. I said he didn’t have way to get there. She said she’d send an Uber.

I get calls like that all the time. I’m happy to take them. You have to know how to navigate the system and the questions to ask. And it doesn’t pay to argue with anyone because you’ll be labeled a “difficult patient.”

I’m not blaming anyone at the other place. It’s the system that is sluggish, bound by rules and process. Granted, Trillium is small – 10,000 patients. Some systems have hundreds of thousands. At Trillium, we’ve always said we didn’t want to be like other doctor offices, and for the most part, that’s held up.

But I also wonder what would have happened if the young man had just called us on the phone and had to push buttons before talking to somebody who had other calls waiting.

I wish we could make our health care system less complicated. The system has to get out of the way and get rid of barriers to care. Putting up roadblocks isn’t the way to get good results.