Donna S. Havens, PhD, RN, FAAN, Connelly Endowed Dean and Professor of the M. Louise Fitzpatrick College of Nursing, is a health systems researcher who studies how healthcare is delivered, financed, organized, and what its outcomes are.
What keeps me up at night is how people are going to be able to pay for healthcare. And I’m very, very concerned about the state of things for the elderly.
As a public health nurse years ago, I would see, and I think it’s gotten worse, people not take their blood pressure medicine until the day they knew I was coming to take their blood pressure, because they knew they couldn’t afford to renew their prescriptions as they were supposed to, so they would wait and spread it out. And I’m hearing anecdotally that the same thing is happening today and it may even be worse, that they may have to pay for food for the family and can’t afford the prescriptions or their rent.
I’m worried about access, meaning how easy it is for people to obtain the healthcare they need. Part of that is related to payment, part of that is related to where you live. In the rural areas there are fewer healthcare providers, and I’ve learned from my research that it’s not uncommon to have one primary care physician in a rural town who works until 4:30 on a Friday afternoon, which means patients have to go to the ER and that’s going to cost many, many times more than a simple appointment. One way to help alleviate this and to increase access is to allow nurse practitioners to more fully practice to the top of their licenses. They are educated to provide primary care -- not perform open heart surgery -- but they could help alleviate the strain. And the more competent health providers you have in any area, the more people will be able to access the care they need.
Another thing I’m concerned about because of the pandemic and access, is that people are not following up on healthcare appointments, they’re re not getting the tests they need. For instance, mammograms are down 70%. People are postponing because they’re afraid to go to a physician's /nurse practitioner’s office or to go into a healthcare setting. They're afraid of getting sick or being exposed.
We need to look to other countries and how they’re doing healthcare. The U.S. is one of the most highly developed nations in the world, and we have the highest costs for healthcare, but we do not have the best outcomes, we’re in the middle. There are some other countries where people’s care is taken care of by the government or through some other mechanisms, they have better outcomes than we do in terms of children, adults and the aging. Their hospitals may be old but they do have state-of-the-art equipment and technology. I personally evaluated two healthcare systems, one in the UK and one in Ireland, both of which delivered outstanding care. Their infection rates were low, and patients are not paying for what we’re paying for. They’re not getting the Cadillac, they don’t want the Cadillac. But they want quality, and in my opinion they were getting quality.