Challenges in Accessing Healthcare Services

The Challenges of Running Telemedicine Startups in Nigeria. I co-founded and ran Wellvis Health (acquired by WellaHealth) between 2017 and 2022. Telemedicine in Nigeria didn’t begin with apps like HiDoctor or Kangpe it actually started with the introduction of GSM phones. Yet, despite the promise to improve healthcare access and bridge the doctor-patient gap, many telemedicine startups have struggled or gone extinct. Why? The challenges run deep. 1️⃣ Pricing & Payment Problems The biggest question for any telemedicine startup: How much should you charge? Charge too low, and you won’t generate enough revenue to pay doctors. Charge too high, and most Nigerians won’t pay especially because healthcare spending isn’t a priority for many. 2️⃣ Limited Addressable Market While smartphone penetration is over 50%, the number of Nigerians willing (and able) to pay for telemedicine is small. You either need: • High prices (which reduces adoption) • High volume (which is tough with limited demand) 3️⃣ Health-Seeking Behavior Mismatch Here’s the reality, Nigerians don’t seek healthcare like you might expect. When sick, many people: • Ask a friend for advice. • Visit the local chemist (PPMV) for diagnosis & meds often without consultation fees. Telemedicine, on the other hand, charges for virtual consultations while providing no immediate access to drugs or tests a mismatch with how most Nigerians access care. 4️⃣ Doctor Availability Ironically, the doctor shortage that telemedicine aims to solve also hinders its success. Most doctors already work full-time in hospitals, offering telemedicine on the side if at all. And here’s the challenge: doctors make more money attending physical patients than virtual ones, making it tough for startups to retain medical staff. There are telemedicine startups that are still going strong. Lots of them use a B2B model by servicing HMOs and government but they are very few. Until these core issues pricing, market size, patient behavior, and doctor availability are addressed, telemedicine startups in Nigeria will continue to struggle with sustainability and scale. #Telemedicine #Nigeria #HealthTech #Innovation

Challenges to Achieving Universal Health Coverage Universal Health Coverage (UHC) remains an elusive goal for many nations due to persistent challenges in equitable access, affordability, and infrastructure. Health inequities rooted in socioeconomic disparities continue to leave millions without adequate care. In low- and middle-income countries (LMICs), insufficient funding and fragmented healthcare systems hinder progress. Moreover, high out-of-pocket expenses drive vulnerable populations further into poverty, creating a vicious cycle that exacerbates inequality. Even in high-income countries, barriers such as rising healthcare costs and coverage gaps for marginalized groups persist, undermining the principle of inclusivity. Another critical obstacle is the shortage and unequal distribution of healthcare workers. Many rural and underserved areas lack sufficient medical personnel to meet community needs, often forcing individuals to travel long distances for basic services. Compounding these issues are global health emergencies like pandemics, which strain healthcare systems, divert resources, and delay progress toward UHC goals. These challenges are further exacerbated by political instability, weak governance, and the lack of commitment to long-term health financing. To achieve UHC, governments and stakeholders must prioritize equitable resource allocation and innovative financing mechanisms. Strengthening primary healthcare systems, investing in workforce development, and leveraging technology can help bridge gaps in service delivery. Public-private partnerships can mobilize resources and drive innovations to expand access. Additionally, policies that protect against catastrophic health expenditures and address social determinants of health—such as education, housing, and sanitation—are critical. Achieving UHC demands a collective, sustained effort to create resilient, inclusive healthcare systems that leave no one behind.

As we approach the holiday season, I find myself reflecting on the systemic challenges in healthcare—challenges that affect patients and healthcare workers alike. Here are some of the most pressing issues I am currently seeing as an oncologist: 💻 1. Telehealth at Risk for Medicare, Medicaid, United Health, and VA Patients: If Congress doesn’t act, millions of patients relying on these programs could lose access to telehealth. For cancer patients or those in rural areas, telehealth is a lifeline. Losing it would increase healthcare disparities, delay critical care, and harm patient outcomes. ⏳ 2. Prior Authorizations We waste countless hours on prior authorizations and peer-to-peer reviews, fighting for treatments we know our patients need. These delays create unnecessary stress and, in oncology, can mean life-or-death consequences. The administrative burden on healthcare workers also contributes significantly to burnout. 💔 3. Physician Shortages and Burnout Burnout, frustration with inefficiencies, and a lack of systemic support are driving clinicians out of medicine. This shortage leads to delays in care, later diagnoses, and poorer outcomes for patients. To fix this, we must focus on retaining and supporting healthcare workers. ⚖️ 4. Criminalization of Reproductive Healthcare Healthcare decisions are increasingly being politicized, with women and their physicians treated like criminals for accessing or providing necessary care. This creates a chilling effect on care, forcing healthcare workers to navigate legal fears instead of prioritizing patient needs. 💸 5. Physicians Are NOT Driving Healthcare Costs Doctors’ salaries are often scapegoated for rising healthcare costs, but the truth is that physicians’ pay accounts for <10% of total healthcare spending. The real cost drivers include administrative overhead, pharmaceutical pricing, and insurance inefficiencies. Physicians are not the problem; they’re advocates for patients navigating a broken system. 🚨 6. The Mental Health Crisis Among Healthcare Workers The toll of navigating these systemic barriers is immense. Clinicians often neglect their own mental health while balancing heavy workloads and systemic inefficiencies. Addressing burnout is not just about personal wellness—it’s a public health imperative. 📉 7. The Dangers of Prioritizing Cost Over Patient Safety The recent allegations against Amazon One highlight the risks of prioritizing cost-cutting and productivity over quality care. Reducing clinical staff and increased pressure to meet productivity targets are a stark reminder that healthcare isn’t like other industries. When efficiency and profit are prioritized over safety and good patient care, lives are at stake. As we move into 2025, I hope we can focus on building a healthcare system that prioritizes patients and supports the clinicians and staff who care for them. Change is possible, but it will require systemic transformation and collective advocacy.

A petition📖for reparations for American Descendants of Slavery (ADOS) is justified by historical evidence of policies that have critically harmed the black community. Exhibit B: Healthcare Policies The lack of adequate investment in healthcare infrastructure within (ADOS) communities has played a significant role in exacerbating disparities. Healthcare policies have had detrimental effects on ADOS individuals, leading to elevated rates of chronic illnesses and limited availability of high-quality healthcare services. The Flexner Report of 1910 directly addressed race within healthcare, highlighting disparities in access to and quality of healthcare services based on race. It revealed that African Americans were often segregated and restricted to receiving care in facilities designated for "colored" or "negro" individuals, which were typically underfunded and lacked necessary resources compared to those serving the white population. Also, the report criticized medical schools that discriminated against minorities in admissions policies, limiting opportunities for aspiring minority physicians to receive proper medical education and training. This perpetuated a cycle of healthcare inequality, as minority communities struggled to access competent and culturally sensitive healthcare providers. Numerous instances have demonstrated how flawed healthcare policies have worsened disparities within communities over time: 1. Limited access to affordable health insurance may hinder individuals from receiving vital medical treatment, leading to increased disparities in health outcomes. 2. Inadequate funding for community health centers may prevent individuals in underserved areas from receiving necessary primary care services, resulting in disparities in preventive care and chronic illness management. 3. Failure to address social determinants of health, such as poverty, education, and housing, through healthcare policies can perpetuate inequalities within communities by inadequately addressing the root causes of health disparities. 4. The lack of culturally sensitive care in healthcare policies can subject individuals from marginalized communities to discrimination and bias in healthcare settings, contributing to disparities in health outcomes and access to care. 5. Disregarding systemic racism in healthcare policies can compound disparities for communities of color, leading to unequal access to quality care and inferior health outcomes. #policychange

The United States healthcare system faces a daunting challenge: a critical shortage of physicians. This shortage is not just a numerical issue; it profoundly affects access to care and the quality of medical services. The challenges are multifaceted, stemming from various factors, including demographic shifts and policy decisions, notably the Balanced Budget Act of 1997 (that’s a minute ago)! The ageing population of the United States is a crucial driver behind the increased demand for healthcare services. As people live longer, they require more medical attention, thus increasing the need for physicians. Compounding this issue is that a significant portion of the current physician workforce is approaching retirement. This imminent wave of retirements threatens to deplete a strained pool of medical professionals. Another crucial factor contributing to the shortage is the bottleneck in medical education. The capacity of medical schools and residency programs, vital for training new physicians, is limited. These educational bottlenecks restrict the number of physicians entering the workforce, failing to keep pace with the population's growing demands. The physician shortage brings several challenges to the forefront. Patients nationwide, especially in rural and underserved areas, face longer wait times, delaying necessary care. These delays can lead to worsened outcomes and increased medical expenses. Additionally, the existing physicians, facing increased workloads, are at a higher risk of burnout, further compromising the quality of care. A significant policy decision that has contributed to this crisis is the Balanced Budget Act of 1997. This Act imposed a cap on federal funding for residency training programs, which has impacted the number of physicians trained each year. With reduced funding, teaching hospitals, which play a critical role in training physicians, have struggled to maintain or expand residency programs, directly impacting the physician workforce. For policymakers, addressing the physician shortage requires a comprehensive approach. Revisiting the funding caps imposed by the Balanced Budget Act and exploring ways to expand residency slots is a crucial step. Additionally, encouraging medical schools to adopt innovative educational models that can increase the throughput of medical students is essential. Finally, leveraging technology and other healthcare professionals, such as nurse practitioners and physician assistants, can help fill the gaps in care. As the country navigates this crisis, it is imperative to consider both the supply of physicians and the evolving healthcare needs of the population. Strategic policy revisions, a focus on equitable access to medical education, and innovative solutions are crucial to resolving this critical healthcare system challenge. #healthcare

The news from Walmart and several other big companies recently shutting down their healthcare operations paints a bleak picture for improving healthcare access and just how hard it is to form a sustainable business model. But where one fails is another’s opportunity and I am hopeful there are great thinkers and doers, especially physician leaders who are inspired to keep trying. It is no surprise to me that shortage of healthcare workers is one of the main challenges to operating its health clinics, as noted from this excerpt below: “Robert Field, a professor of health management and policy at Drexel University, said Walmart had many challenges with its health clinics, including a shortage of healthcare workers. He also noted that the company's strength in retail did not guarantee its success in the healthcare field. "It is different from selling products, like toothpaste and breakfast cereal, and requires different kinds of expertise and management," Field said. According to CNN, Walmart's health clinic closures may leave patients, particularly those with lower incomes or without insurance, with gaps in healthcare access. "One of unique things was they were focused on stores located in underserved communities," Ateev Mehrotra, a professor of healthcare policy and medicine at Harvard Medical School. "It's disappointing that Walmart wasn't able to make it work because these patients need care and don't have as many options." #primarycare #physicianshortage #healthcareoperations #telehealth #ruralhealth #healthcareaccess #healthequity