Tools, Technologies and Training for Healthcare Laboratories

Global and Local Imperatives for US Healthcare

January 2007

After traveling to five continents in 2006, Dr. Westgard gained a new perspective on US healthcare. As our healthcare system fails, the world is watching.

While traveling in South Africa, I came across an interesting article “Why Healthcare is Dysfunctional”, which appeared in the December 4, 2006, issue of the Cape Times. It was written by Solly Benatar, who is a Professor of Medicine and Director of the Bioethics Center at the University of Cape Town.

US healthcare expensive but not efficient

Professor Benatar provided some interesting observations about US healthcare:

  • Healthcare expenditures in the US amount to “50% of all money spent on healthcare in the world each year” but cover only 5% of the world’s population;
  • "annual per capita health care expenditure[in the US] is more than $5000 (15% of GDP)”;
  • [Yet] “45 million Americans lack access to healthcare”; and
  • “healthcare outcomes are not as good as in Canada or Western Europe”.

The US is first in the amount of money spent on healthcare and may have the best healthcare money can buy, but clearly you have to have money to get quality healthcare in the US. According to Professor Benatar, the British spend only 7% of GDP, have universal coverage, plus have better health outcomes. Most of Western Europe also spends less and gets better outcomes.

I had seen most of these figures before, but not the figure that the US spends 50% of all the money spent on healthcare worldwide to address the needs of only 5% of the world’s population (and then we don’t actually provide healthcare to about 15% to 20% of our own population). We tend to rationalize that our market driven healthcare system is “efficient” because it provides the best quality to those who can afford it, but when viewed globally, we are seen to be wasting resources without regard for what’s good for all of our population and certainly without regard for the rest of the people on this planet.

Global implications

Professor Benatar points out that US inefficiencies have a global impact:

  • almost 90% of global annual healthcare resources are spent on 16% of the world’s population who bear 7% of the burden of disease, and
  • 90% of medical research expenditures are on diseases responsible for 10% of the global burden of disease.

In short, the trends we see in the US regarding inequality in healthcare – i.e., the rich get the best healthcare and the poor may not even have access to healthcare – are also seen worldwide. Given the US’s undisputed position as the largest spender on healthcare and given the US leadership in medical research, does that not mean we bear some responsibility for the misdirection of healthcare resources worldwide? And the corollary – don’t we also bear an increasing responsibility to address global healthcare issues?

Professor Benatar cites two main reasons for the dysfunctional global healthcare system:

  • “Medicine is increasingly driven by the imperative to use expensive technology excessively and often wastefully”
  • “Current economic trends (led by blind faith in free market polices) are widening the gap between rich and poor, and shifting medicine away from a caring social service towards an increasingly commercialized activity benefiting mainly those who can pay.”

US healthcare certainly epitomizes this dysfunctionality and quite likely contributes to a similar dysfunctionality on a global basis. While the US has now grudgingly accepted that global warming is a serious problem that requires a coordinated worldwide effort, there is less understanding that global healthcare also requires a coordinated worldwide effort.

Why is this relevant to US healthcare today?

There are many indications that the US healthcare system is broken! There also is a growing awareness that the “fix” may require a major change from today’s “money-driven medicine,” a term which epitomizes our current healthcare system. For a revealing history and discussion of US healthcare, see Maggie Mahar’s book Money-Driven Medicine: The real reason healthcare costs so much . Mahar makes the point that the free market has not worked in healthcare because customers cannot make the quality versus cost trade-off decisions. Instead we end up with a supply-driven market, where new technology and new services lead to increased use and higher costs. This is the “if you build it they will come” model that we can see all around us today in the new facilities that accommodate the new services and new technology for healthcare.

I have often thought that the cost of healthcare in the US is just our own problem and therefore we only have ourselves to blame. But, in today’s global economy, it appears that many others have US to blame for their healthcare problems!

Why is this relevant to US laboratories?

Professor Benatar also pointed out that rich nations often exploit the workforce of poor nations. For example, in 2000, 23% to 28% of the physicians in the US, UK, Canada, and Australia were international medical graduates. Likewise, the nurse shortage in Western Nations is now being addressed by importing nurses from other countries. Should laboratories also take this approach to solving our current personnel shortage?

Professor Benatar would urge us solve this problem on our own! “Without any sense of shame or consideration of recompense, wealthy countries, which have not trained enough professionals for their own needs, recruit health professionals trained in developing countries. This is just one of the many sad manifestations of a world in which the quest for continuous economic growth by the wealthy thrives on depriving others.”

As we look to the future needs for clinical laboratory scientists, we must recognize the need to expand our own education and training programs, rather than depend on others to provide us with those professionals. Some organizations are recognizing this need: for example, Mayo Clinic is expanding its training activities to compensate for the shortage of Clinical Laboratory Scientists; Abbott has committed a million dollars to the support of education and training programs in the US.

Why is this relevant to you?

While some organizations are taking steps in the right direction, we need a much larger investment to support the future need for Clinical Laboratory Scientists. We cannot depend on our Medical Schools to maintain programs in allied health professions. From personal experience, I can tell you that Medical Schools deprive allied health professions of needed support. While putting the education of Doctors first and foremost is understandable, doing so by starving other healthcare professions is short-sighted and dangerous. Unfortunately, even Departments of Pathology and Laboratory Medicine put CLS education at the lowest level, after MD courses, PhD programs, and Residency training. Without the advocacy of each of us, the continuation and expansion of the education and training programs for Clinical Laboratory Science in our communities and our states will not happen. All of us need to raise our voice.


James O. Westgard, PhD, is a professor of pathology and laboratory medicine at the University of Wisconsin Medical School, Madison. He also is president of Westgard QC, Inc., (Madison, Wis.) which provides tools, technology, and training for laboratory quality management.