With increased access hospitals will strain to meet demand of new patients

There is no doubt about one of the problems that will come in many areas with the increased access to care that the implementation of the Affordable Care Act will cause. With more people having insurance and a way to pay for care, many hospitals and clinics that are already near capacity will strain to provide timely medical care for the influx of new patients. This has been evidenced in many countries with universal care. While universal access and universal care are miles apart, this issue is certain to follow.

In the US in 2012 less than 20% of patients had a weight of greater than 4 weeks to see a specialist. In both Canada and the UK this accounted for about 60% of patients. To take advantage of the benefits of better access while avoiding the pitfalls that come with that, the medical industry needs to look into better ways providing care to those in need and identifying the patients more in need. The answer to that may be found in the science of genetics.

Using DNA for Risk Assessment

Genetic Pre-disposition is a proven method of assessing risk

The use of genetics in medical diagnostics is hundreds of years old. We did not call it DNA testing, it was hidden in a much less technical jargon when the Doctor asked if anybody in your family had cancer and in the medical history questionnaires we all fill out on the first visit to a new Doctor’s office. Because of the known hereditary factors of many diseases, it makes one diagnosis far more or less likely than another. The problem with a medical history is it depends on the accuracy and even honesty of the person completing it. As an example, while mental illness often has a hereditary factor, few people are willing to divulge that family history on a questionnaire when they are on a visit for a sore throat. That history however becomes a permanent part of their medical chart.

It is also common now where due to divorce or geographical separation of extended families, many people cannot answer accurately if they wanted to. In the case of adopted children their is often no family medical history available at all. The combination of accuracy, honesty, and even knowledge of family medical history makes these questions a hint rather than a clue. This can be rectified by science with basic non-intrusive genetic testing that makes all of these questions moot and allows a physician to rely on fact instead of guesswork.

The key to an accurate assessment of pre-disposition is DNA

Genetic predisposition testing is available from many private genetic testing laboratories. The cost is typically around $450. This cost is often quoted as the reason it is not done on a regular basis and people need to purchase it on their own if they want to know their true risk to many cancers and diseases. Risk can be determined by genetic testing in a range of “more likely than the general population” with many cancers and diseases to 100% in the case of some diseases like familial ALS (Lou Gehrig’s Disease).

The initial cost of this testing is dwarfed however by the reduction in additional testing in the form or blood tests, MRI’s, mammograms, etc. that all cost more than a single genetic test while being administered purely as a precaution or based on a calendar date. Freeing up these diagnostic tests done on people with extremely low risk will increase availability of these tests to people at much higher risk.

Additionally, if testing became commonplace, not only would the cost of testing be significantly decreased, the accuracy and scope of testing would grow exponentially. This would all contribute to more efficient allocation of resources to the patients with greatest need. Since DNA never changes, even as new breakthroughs arrive , there would be no need to repeat the DNA testing. It would be adequate to simply re-interpret the old test with the new information.

More Accurate Diagnosis Means Better Care

Improved Science for better healthcare is the way forward

With better diagnostics and risk assessments the incidence of repeated trips to the Doctor’s office for the same thing could be drastically reduced and the effectiveness of treatment would improve greatly. This would allow more people to use the currently available medical facilities for better access and shorter wait times, while improving health and efficacy of treatments.

With the elimination of an insurance companies ability to charge different rates for pre-existing conditions by the Affordable Care Act, we have also reduced the risk that getting genetic testing could result in increased costs for some people. Whether it is an increased risk factor or an actual condition, the insurance rates will not change. Additionally, insurance companies would ultimately experience a decrease in costs for routine testing, so this would be a win for the public, the hospitals, and business. There is no point in relying on written medical questionnaires as opposed to real science anymore.