People with ongoing or specialist care needs

Paths that fix these help them.

• People lose coverage when their life changes (churn): Treatment is interrupted when coverage lapses mid-course.
• Underinsurance: covered, but can't afford to use it: High deductibles and coinsurance lead them to avoid care.
• Narrow networks and out-of-network surprises: Needed specialists and therapists are often out of network.
• Medical debt affects about 100 million people: Medical debt leads them to skip care and face damaged credit and financial distress.
• Surprise billing and a runaway arbitration system: Ambulance rides and out-of-network specialists send bills patients didn't choose.
• Claim denials: Care is delayed or denied, and appeals take time.
• Prior authorization delays and blocks care: Approval requirements delay treatment and can cause harm.
• Private equity roll-ups in medicine: Practice and facility buyouts can raise prices and cut staff.
• Patent thickets and evergreening delay generics: Extended monopolies keep them paying monopoly prices longer.
• R&D is funded by high prices, which ties innovation to unaffordability: High prices make current treatment less affordable.
• Drug shortages of cheap, essential generics: Essential generic shortages interrupt access to chemotherapy and emergency drugs.
• Getting to care: transportation and ambulances: Lack of transportation causes missed appointments.
• Nursing and direct-care shortages and burnout: Understaffed hospitals and nursing homes leave them with too few caregivers.
• Clinician burnout from paperwork and EHR work: Paperwork leaves less face time with clinicians.
• Medical errors and poor care coordination: Delivery and coordination failures cause preventable harm.
• Malpractice system: slow, costly, and drives defensive medicine: Most patients injured by care never receive compensation.
• Low-value care and overtreatment: Low-benefit tests and treatments expose them to harm.
• Hospice growth, for-profit entry, and fraud: Inappropriate hospice enrollment can remove access to curative treatment.
• Prevention and public health are underfunded: Limited prevention funding leaves chronic disease driving treatment needs.
• Records don't follow patients: Incompatible records lose information across providers and cause repeated tests.
• Health privacy: Widely shared sensitive health information can expose them to harm.
• Longer waits if demand grows faster than capacity: They need specialists and procedures most often.
• Under-investment in equipment and facilities: Underinvestment in diagnostic equipment leaves them waiting for tests.
• Slower access to new drugs and technology: Strict value assessment can delay or refuse new therapies.
• Providers leave, retire, or go cash-only if pay drops: Provider retirements, opt-outs, and closures reduce access in affected specialties and regions.
• Copays keep billing systems alive and still deter poorer patients: Point-of-care charges deter care, especially for poorer patients.
• Central coverage decisions can feel like rationing: People needing a declined or delayed treatment have no other insurer to turn to.
• Fixed budgets can ration care: Hospitals may slow elective procedures when demand exceeds fixed budgets.
• Paying a fixed amount per patient rewards doing less: Fixed payments encourage avoiding sick patients or providing less care.
• Price limits can cause shortages, launch delays, or exits: Low price limits may reduce access to products and services through shortages or exits.
• Government chooses which research gets funded: People with rare conditions can lose research support for needed treatments.
• Quality concerns when non-physicians practice independently: Expanded independent practice may expose them to missed diagnoses or over-prescribing.
• Targets and quality metrics invite gaming: Gaming wait-time and quality measures undermines their intended protection.