June 22, 2024

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Americans

2 min read

When it comes to saving American lives, don’t look to cardiologists, oncologists or even the made-for-TV heroes in the ER. It’s primary-care providers who offer the best hope of reversing the devastating decline in U.S. life expectancy.

That’s the conclusion reached by experts who study America’s fractured health-care system.

A 2019 study based on U.S. population data and published in JAMA Internal Medicine found that every 10 additional primary-care physicians per 100,000 people was associated with a 51.5-day increase in life expectancy.

That finding comes after decades of research — and mounting frustration — from health-system experts who have argued for more investment in the accessible, comprehensive, community-based services that allow countries with far fewer resources, including Chile, Costa Rica and Portugal, to make gains while the United States founders in the survival stakes.

Without patients having access to primary care, minor complaints evolve into chronic illnesses that demand complex long-term treatment plans. Addressing basic patient problems in the emergency room costs up to 12 times what it would in a primary-care office, resulting in billions of additional dollars each year.

But even as evidence mounts that access to primary care improves population health, reduces health disparities and saves health-care dollars, the field is attracting fewer and fewer medical students. The remaining small-group medical practices are being replaced by concierge offices with steep annual membership fees.

In response, the Department of Health and Human Services is making a commitment to strengthen primary care for all Americans and has been soliciting input from health-care providers, unpaid caregivers, health technology developers and others to establish what role the government can play. And in September, Sens. Bernie Sanders (I-Vt.) and Roger Marshall (R-Kan.) announced a $26 billion bipartisan bill aimed at expanding primary care and reducing staffing shortages.

Meanwhile, the business of primary care is in upheaval, with investors banking on integrating the historically fragmented industry with pharmacy and specialist care.

Giant retailers including Amazon, CVS and Walmart are spending billions of dollars to enter the market, promising to transfer their trademark online ordering and one-stop shopping to primary care. And venture capitalists are investing rapidly in value-based care, a model that reimburses providers based on positive outcomes rather than rewarding them for treatment they offer after patients fall sick.

All of which puts a big question mark over the future of primary care.

“Who is going to win this race? I don’t know,” said David B. Nash, a physician and professor of health policy at the Jefferson College of Population Health at Thomas Jefferson University in Philadelphia.

“Can America improve health? That’s the key question.”

The problems undermining primary care were exacerbated by the coronavirus pandemic, according to a report by the Commonwealth Fund, a nonprofit that supports research on health-care issues. But the erosion had been underway for years. From 2005 to 2015, the prevalence of primary-care physicians in the United States fell by 11 percent, from 46.6 to 41.4 doctors per 100,000 people.

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3 min read

Yet many see promise for artificial intelligence to help issues of bias in medical care

Pew Research Center conducted this study to understand Americans’ views of artificial intelligence (AI) and its uses in health and medicine. For this analysis, we surveyed 11,004 U.S. adults from Dec. 12-18, 2022.

Everyone who took part in the survey is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way, nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology.

Here are the questions used for this report, along with responses, and its methodology.

This is part of a series of surveys and reports that look at the increasing role of AI in shaping American life. For more, read “Public Awareness of Artificial Intelligence in Everyday Activities” and “How Americans view emerging uses of artificial intelligence, including programs to generate text or art.”

A new Pew Research Center survey explores public views on artificial intelligence (AI) in health and medicine – an area where Americans may increasingly encounter technologies that do things like screen for skin cancer and even monitor a patient’s vital signs.

Chart shows fewer than half in U.S. expect artificial intelligence in health and medicine to improve patient outcomes

The survey finds that on a personal level, there’s significant discomfort among Americans with the idea of AI being used in their own health care. Six-in-ten U.S. adults say they would feel uncomfortable if their own health care provider relied on artificial intelligence to do things like diagnose disease and recommend treatments; a significantly smaller share (39%) say they would feel comfortable with this.

One factor in these views: A majority of the public is unconvinced that the use of AI in health and medicine would improve health outcomes. The Pew Research Center survey, conducted Dec. 12-18, 2022, of 11,004 U.S. adults finds only 38% say AI being used to do things like diagnose disease and recommend treatments would lead to better health outcomes for patients generally, while 33% say it would lead to worse outcomes and 27% say it wouldn’t make much difference.

These findings come as public attitudes toward AI continue to take shape, amid the ongoing adoption of AI technologies across industries and the accompanying national conversation about the benefits and risks that AI applications present for society. Read recent Center analyses for more on public awareness of AI in daily life and perceptions of how much advancement emerging AI applications represent for their fields.

Asked in more detail about how the use of artificial intelligence would impact health and medicine, Americans identify a mix of both positives and negatives.

On the positive side, a larger share of Americans think the use of AI in health and medicine would reduce rather than increase the number of mistakes made by health care providers (40% vs. 27%).

And among the majority of Americans who see a problem

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3 min read

Substitute teacher Crystal Clyburn, 51, doesn’t have health insurance. She got her blood pressure checked at a health fair in Sarasota, Fla.

Stephanie Colombini/WUSF


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Stephanie Colombini/WUSF


Substitute teacher Crystal Clyburn, 51, doesn’t have health insurance. She got her blood pressure checked at a health fair in Sarasota, Fla.

Stephanie Colombini/WUSF

At a health-screening event in Sarasota, Florida, people milled around a parking lot waiting their turn for blood pressure or diabetes checks. The event was held in Sarasota’s Newtown neighborhood, a historically Black community.

Local resident Tracy Green, 54, joined the line outside a pink and white bus offering free mammograms.

“It’s a blessing, because some people, like me, are not fortunate and so this is what I needed,” she said.

Green said she wanted the exam because cancer runs in her family. And there’s another health concern: her breasts are large and cause her severe back pain. A doctor once recommended she get reduction surgery, she said, but she’s uninsured and can’t afford it.

In a recent Gallup poll, 38% of Americans surveyed said they had put off medical treatment last year due to cost, up from 26% in 2021. The new figure is the highest since Gallup started tracking the issue in 2001.

A survey by The Kaiser Family Foundation last summer showed similar results. It found people were most likely to delay dental care, followed by vision services and doctor’s office visits. Many didn’t take medications as prescribed.

The health screening event is part of an ongoing effort provide health services to low-income Floridians who are uninsured. Attendees could have their blood pressure checked or receive screenings for diabetes. A bus also delivered mammogram services.

Stephanie Colombini/WUSF


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The health screening event is part of an ongoing effort provide health services to low-income Floridians who are uninsured. Attendees could have their blood pressure checked or receive screenings for diabetes. A bus also delivered mammogram services.

Stephanie Colombini/WUSF

The neighborhood screening event in Newtown — organized by the non-profit Multicultural Health Institute in partnership with a local hospital and other health groups — is part of an effort to fill in the coverage gap for low-income people.

Tracy Green explained that her teeth are in bad shape too, but dental care will also have to wait. She doesn’t have health insurance or a stable job. When she can, she finds occasional work as a day laborer through a local temp office.

“I only make like $60 or $70-something a day. You know that ain’t making no money,” said Green. “And some days you go in and they don’t have work.”

If she lived in another state, Green might have been able to enroll in Medicaid. But Florida is one of eleven remaining states that haven’t expanded the program to cover more working-age adults. With rent and other bills to pay, Green says her health is taking a backseat.

“I don’t have money to go to the dentist,

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2 min read

Jeni Rae Peters and daughter embrace at their home in Rapid City, S.D. In 2020, Peters was diagnosed with stage 2 breast cancer. After treatment, Peters estimates that her medical bills exceeded $30,000.

Dawnee LeBeau for NPR


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Jeni Rae Peters and daughter embrace at their home in Rapid City, S.D. In 2020, Peters was diagnosed with stage 2 breast cancer. After treatment, Peters estimates that her medical bills exceeded $30,000.

Dawnee LeBeau for NPR

RAPID CITY, S.D. ― Jeni Rae Peters would make promises to herself as she lay awake nights after being diagnosed with breast cancer two years ago.

“My kids had lost so much,” said Peters, a single mom and mental health counselor. She had just adopted two girls and was fostering four other children. “I swore I wouldn’t force them to have yet another parent.”

Multiple surgeries, radiation, and chemotherapy controlled the cancer. But, despite having insurance, Peters was left with more than $30,000 of debt, threats from bill collectors, and more anxious nights thinking of her kids.

“Do I pull them out of day care? Do I stop their schooling and tutoring? Do I not help them with college?” Peters asked herself. “My doctor saved my life, but my medical bills are stealing from my children’s lives.”

Cancer kills about 600,000 people in the U.S. every year, making it a leading cause of death. Many more survive it, because of breakthroughs in medicines and therapies.

But the high costs of modern-day care have left millions with a devastating financial burden. That’s forced patients and their families to make gut-wrenching sacrifices even as they confront a grave illness, according to a KHN-NPR investigation of America’s sprawling medical debt problem. The project shows few suffer more than those with cancer.

About two-thirds of adults with health care debt who’ve had cancer themselves or in their family have cut spending on food, clothing, or other household basics, a poll conducted by KFF (Kaiser Family Foundation) for this project found. About 1 in 4 have declared bankruptcy or lost their home to eviction or foreclosure.

Other research shows that patients from minority communities are more likely to experience financial hardships caused by cancer than white patients, reinforcing racial disparities that shadow the U.S. health care system.

“It’s crippling,” said Dr. Veena Shankaran, a University of Washington oncologist who began studying the financial impact of cancer after seeing patients ruined by medical bills. “Even if someone survives the cancer, they often can’t shake the debt.”

Shankaran found that cancer patients were 71% more likely than Americans without the disease to have bills in collections, face tax liens and mortgage foreclosure, or experience other financial setbacks. Analyzing bankruptcy records and cancer registries in Washington state, Shankaran and other researchers also discovered that cancer patients were 2½ times more likely to declare bankruptcy than those without the disease.

And cancer patients who went bankrupt were more likely to die than those who did not.

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