The document is a final reflection paper on improving the US healthcare system. It argues that while the US spends the most on healthcare, it underperforms compared to countries that spend less. This is due to a lack of cost control, universal access, and transparency. The paper proposes adopting aspects of Singapore and Japan's healthcare models, which emphasize social harmony, personal responsibility, and transparency. It suggests establishing a flat fee for all healthcare services paid by providers to control costs and incentivize value-based care between payers and providers. Overall the paper argues the US could lower costs by improving collaboration, transparency, and personal responsibility in the healthcare system.

1. Final Reflection
Cassandra Quinn
Arizona State University
December 6, 2015

2. 1
Why does the United States, the world’s richest country in the world, spend the most
money on healthcare but underperform in comparison to other developed nations that pay less?
Unfortunately there are many answers to this question, but not one single formula for success
when it comes to improving the US healthcare system to being the most efficient in the world.
For such a developed nation, the US fails to control costs and does not guarantee access to
healthcare. Why is it that the same medical procedure performed in the same country can be
more expensive at one place compared to the next? Or that only a certain percentage of the
population has access to healthcare while others are left helpless? The country lacks transparency
on the essential information relative to receiving care such as estimated costs and the quality of
different healthcare services. In addition to this, our nation faces social inequalities that result in
healthcare only being given to the ones who can afford it. The proposed solution is setting a flat
fee that is paid for by the provider for all healthcare services and generating universal healthcare.
This sounds impossible, but by adopting healthcare system characteristics of countries such as
Japan and Singapore that spend roughly a 5-10% GDP on healthcare expenditures, the US could
ultimately achieve lowering healthcare costs.¹ These countries made it possible by emphasizing
“social harmony”, personal responsibility, and transparency- all things that our nation could learn
from these two countries, and implement for beneficial change.
It’s no surprise that the lack of knowledge on the costs of healthcare procedures will
hinder the treatment process. The fact of the matter is that patients rarely even know the cost of a
procedure until after they receive it because they assume their insurance will cover it. Often
times the price and the quality they are receiving for their treatment do not equate. To state it
simply- a higher price does not necessarily mean higher quality. This alone is a contributing

3. 2
factor to America frivolously spending their money and wasting it. An issue in our system is that
we are instilling competition in the wrong area. Rather than sparking competition in the
physicians by holding their care accountable, the competition lies within the different insurance
companies where the consumer satisfaction isn’t the main priority. Instead, the money gained in
their pocket is the main concern. In fee for service care where providers make more money on
the tests and procedures they perform without any accountability on the care that is given, it’s no
wonder why healthcare costs are so high. When you incentivize the provider with
reimbursements based on the value of care given and keeping patients healthy, the cost of
healthcare will go down. When providers are given the opportunity to profit from delivering care
at a lower cost than contracted amounts, the incentive of competing to provide the most valuable
care is driven. If a healthcare provider treats the patient with an amount that is higher of lower
than the flat fee price that was established by the provider to cover the cost of care for a patient,
the providers share in savings or losses with the payer. This drives the incentive to provide care
at the most efficient level, reducing costs and increasing the quality of care. The shift to value-
based care requires collaboration between payers and providers, the last stakeholder on the list is
the patient.
Establishing a healthcare system that is developed with the basic fundamentalism of
consumer transparency seems straightforward, but requires participation and collaboration from
all three stakeholders: the payer, the provider, and the patient. The issue of delivering quality
care at a reduced rate has been addressed, but now the dilemma is how the nation will pay for it
and how it will incentivize the consumer, or better yet, guarantee coverage for everyone. The
notion of guaranteed access to care is granted by universal healthcare. Singapore holds social

4. 3
harmony as a priority in their system. This means ensuring that everything in society works well
and smoothly by not denying anyone healthcare no matter who they are. This eliminates
vulnerable populations and creates equality for everyone. Singapore has made universal care
possible through government subsidies and by requiring all individuals to contribute private
individual savings of healthcare through funds so that everyone is granted access to care.² Both
employers and employees are required to contribute a percentage of their salary to payroll taxes,
while the self-employed contributions are based on income. Most would argue that this is too
socialized so a happy medium must be met. What if individual costs to healthcare could be
lowered by your health? The healthier you are, the lower your insurance premium. This
incentivizes the consumer to stay healthy. Currently we have a system where the patient is
provided with no incentive to stay healthy. If right now they can live unhealthy or live healthy
and still receive the same coverage, the popular response is to live unhealthy. Which is especially
easy when we live in a world that makes it more convenient to do so. To further this initiative,
there can be actions made to help eliminate unhealthy behavior. Sin taxes would be placed on
sugar and tobacco products. Sounds very extreme but this could go one of two ways. Either the
healthcare system will receive increased funding from people who would continue to participate
in these risky behaviors, or the population would slowly stray away from these habits and over
time receive healthier population outcomes. So those living unhealthy lifestyles would ultimately
be paying the consequences, but how else can you promote healthy behavior if there is no
penalty for living unhealthy? The rest of the required funding coming from people’s paychecks
could hopefully be lowered over time. This process is very long term oriented, but could achieve
hopefully better results.

5. 4
Lastly I will explain the initiatives of the whole healthcare organization that will make
this all possible. Physicians will be provided with resources that inform them of the exact costs
of healthcare procedures to gain awareness and initiate the process of cutting costs where
needed. By determining which procedures are absolutely necessary for the best quality care, and
performing them only if the cost of that procedure is the most efficient method. Next, both the
physician and patient are rewarded if the patient is healthy. The physician faces the possibility of
profiting from insurance companies and the patient has the opportunity to lower their insurance
premiums. Personal responsibility of maintaining good health would be underway due to the
possible benefits and penalties the individual would face. Overtime, chronic conditions (the most
common diseases that cause death) could be reduced, and the nation could focus their attention to
other prevalent diseases.³
Whether a healthcare provider or an insurance payer, the success in evolving the US
healthcare system depends on improving the quality of care provided, reducing costs, and
improving access. This can be possible by creating better transparency of care, collaboration of
all parties, and initiating personal responsibility. The process is very long term, but could
ultimately lead to the US spending a lower amount on healthcare expenditures. The United States
has the potential to have a very successful and efficient healthcare system, it just needs to make a
few adjustments before achieving better results.

6. References
1. Singapore. World Health Organization. Available at:
http://www.who.int/countries/sgp/en/. Accessed July 2015.
2. International Profiles of Healthcare Systems. Commonwealthfund.org. Available at:
http://www.commonwealthfund.org/~/media/files/publications/fund-
report/2015/jan/1802_mossialos_intl_profiles_2014_v7.pdf. Accessed July 2015.
3. Chronic Disease Overview. Centers for Disease Control and Prevention 2015. Available
at: http://www.cdc.gov/chronicdisease/overview/. Accessed July 2015.