Navigating The American Health Care System as An Older Adult
By: Brad Hankins
Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program
I have spent 43 years in the American healthcare system, as a clinical Nurse, clinic administrator and hospital COO. When I entered healthcare in 1982 records were kept on paper, a patient chart was a few pages thick and hospital admissions were published in local newspapers. Things have changed.
Over the course of my career one of the biggest changes I have witnessed is healthcare moving from a human service provided and governed at the local level to the rise of regional and national for profit health care systems such as HCA and Tenet. Though most hospitals remain non-profit, approximately 36 percent are now for profit up from less than 10 percent in 1982.
I have also been witness to near unbelievable transformations in technology, from MRI and PET scanners to robotic assisted surgery and recombinant DNA medications. Technology has not only improved the quality of healthcare but also safety and accessibility. However, it has come at a literal cost.
The ever-increasing cost of medical technology has been one, but far from the only, cause of escalating healthcare costs. The aging of the American population and associated demand for healthcare services also has increased costs of staffing, education, buildings and information infrastructure.
As the American healthcare system has grown so has its regulatory oversight as well as billing/reimbursement processes. Both of which play their own role in increasing costs while at the same time helping ensure the quality of, and payment for, healthcare services are at par across the nation.
With all that said, most health care consumers feel that access, quality and cost of care is getting worse, not better. As I write this in May of 2025, there does not appear to be a clear national path through this escalating quagmire of increasing costs, decreasing access and stalled quality of care. Doubtless, what we are currently experiencing in our healthcare systems will be with us for the foreseeable future.
At the same time, please be assured the vast majority of American healthcare workers and providers are skilled, dedicated and focused on service to others. However, they are limited by the systems they work in. As patients and healthcare consumers how do we successfully navigate our current national and local healthcare systems while maintaining a high level of self-advocacy and results?
I suggest recruiting your own healthcare team, with you as team manager. First, you probably have professional resources available you don’t fully use, pharmacists are an example. They are an excellent consulting/educational resource, they provide injections/vaccinations and are strong advocates. You need a pharmacist on your team, preferably one at a local pharmacy who knows your name.
If you attend exercise classes or work with a personal trainer you also have these professionals readily available as team members. Typically group exercise leaders (yoga, dance, Pilates etc.) and trainers are well versed in the body’s response to exercise and stress and are often underutilized as consultants. Build a consulting relationship with your exercise instructor or trainer, ask them questions and you will be surprised at the value they bring to your team.
A readily accessible medical provider is a must-have team member, with options available from in person to online. Considering today’s access issues, I suggest finding an urgent care clinic that works well for you. Granted you will probably see a different provider each trip, but if the clinic suites you overall, and you go there routinely for minor health issues, e.g. lingering colds, sore throats etc., they will become important immediate care team members.
A medical provider who helps manage your general health is mandatory, especially if you have chronic health conditions such as diabetes or high blood pressure. This may be an MD, DO, Nurse Practitioner, or Physician Assistant that 1) you trust 2) communicates clearly 3) follows up thoroughly/quickly and 4) develops a successful track record of listening to your needs and responding appropriately at each visit. You may have already been their patient for 25 years or you may be currently searching for the right provider, the point is to have a general medical provider on your team who consistently has your best interest at heart and fulfills their obligation to you in a way that meets your expectations and needs.
Specialists are also team members, Neurologists, Orthopedists and Nephrologist being examples. If you are not satisfied with a specialist referral, ask your general provider for a new referral. This may slow access as the new referral is processed but can gain time on the recovery end by assuring you have a specialist who successfully meets your needs. Specialists are important team members and their communications with your general provider is an important part of being on your team – always ensure they send medical records to your general provider.
There are also growing numbers of independent health care professionals who are available either face to face or online. Dieticians, Nurses, Exercise Specialists and Nutritionists are some of the professionals who can be added to your team as consultants and advocates. These services are available on an as-needed basis but are being used more frequently as permanent team members to help navigate care, give professional advice/education, and provide advocation or help develop good self-advocacy skills.
As team manager it is important to have your health care information and data readily available. I recommend becoming your own health records manager. As you add team members, access specialty care or find yourself visiting providers outside your general healthcare system 1) sign up to the patient portal of each clinic or provider 2) download and print your healthcare information from all providers [including your general provider] as it becomes available 3) keep these records at home 4) ensure your general provider has copies of any record outside their system by either delivering printed copies or sending electronic copies.
There are many paths to becoming a good self-advocate and healthcare navigator, these are only my suggestions. However, from years of seeing navigation success and failures I feel an organized team approach gives broad continuity of care and provides access to information from multiple sources to be used in thoughtful decision making. All together an organized team-based plan will help ensure your voice is heard and your healthcare needs are met in a safe, efficient manner.
I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.
Brad Hankins RN, CPT
