TIME just released a poll on American’s perception of the healthcare system. From February to March 2023, 2519 people were surveyed. They assigned a letter grade to the US healthcare system overall:
- 10% – A grade
- 30% – B grade
- 34% – C grade
- 18% – D grade
- 8% – F grade
This means that more than 70% of American feel the US healthcare system was not satisfactory. They also asked what the biggest barriers were to access to healthcare (respondents were able to select multiple options):
- 61% – affordability
- 40% – too focused on profit
- 30% – access to insurance coverage
- 28% – difficulty understanding coverage
- 14% – fractured system
- 13% – inequities and bias in the system
- 13% – lack of primary providers
- 12% – depersonalization
- 12% – lack of healthcare specialists1
The US healthcare system predominantly operates under a medical model, which focuses on the diagnosis and treatment of diseases and illnesses rather than a holistic approach to health and well-being. In this model, the emphasis is often placed on medical interventions, such as medications, surgeries, and procedures, with less attention given to preventive care, health promotion, and addressing the social determinants of health. The medical model tends to view health issues as isolated problems to be solved through medical expertise, often leading to fragmented care and limited consideration of the individual’s broader needs and circumstances. This narrow focus on disease management and profit-driven approaches can result in high healthcare costs, limited access to care for underserved populations, and a system that is more reactive than proactive in addressing health concerns.
Occupational Therapy Philosophy
Occupational therapy provides a unique benefit and value that goes beyond the medical model by adopting a holistic and client-centered approach to care. Unlike the medical model, which primarily focuses on treating diseases or conditions, occupational therapy recognizes the importance of addressing an individual’s overall well-being and quality of life. Occupational therapists understand that health is not merely the absence of illness but a state of optimal functioning and engagement in meaningful activities.
Occupational therapy interventions are rooted in the understanding that participation in meaningful activities is essential for a person’s physical, cognitive, emotional, and social well-being. Occupational therapists work with individuals to identify their personal goals, values, and interests, and then design interventions to enhance their ability to engage in activities that are important to them. These activities can range from self-care tasks, such as bathing and dressing, to work-related activities, leisure pursuits, and social interactions.2
By focusing on the person’s abilities, strengths, and goals, occupational therapy promotes independence, functional performance, and overall well-being. Occupational therapists also consider the impact of environmental and contextual factors on a person’s ability to participate fully in their desired activities. They collaborate with individuals, families, and communities to address barriers and create supportive environments that facilitate meaningful engagement.
By providing interventions that address the broader aspects of an individual’s life and well-being, occupational therapy offers a unique value proposition that goes beyond the traditional medical model. It focuses on enhancing functional abilities, promoting independence, and enabling individuals to actively participate in the activities that matter to them, ultimately improving their overall quality of life.3
Although it may be easy to dismiss this as a systemic healthcare issue, occupational therapy practitioners can play a large role in addressing these perceptions. Starting with the most common – cost, Occupational therapists can play a role in addressing the expensive healthcare system in the United States through various strategies.
A study by Hay and colleagues (2002) concluded that preventive occupational therapy demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures – even across diverse cultural backgrounds.4 Many other studies also suggest that not only is OT itself cost-effective in various settings and for multiple conditions, but this can have a broader impact on the US healthcare system in terms of lowering costs.5 For instance, a study by Nagayama and colleagues (2015) concluded that occupational therapy for older people was clinically effective and cost-effective in comparison with standard care or other therapies.6
Occupational therapists can offer community-based wellness programs that educate individuals on healthy lifestyle choices, exercise routines, stress management techniques, and injury prevention strategies. For example, they may conduct workshops on workplace ergonomics to reduce the risk of musculoskeletal injuries or collaborate with schools to implement programs promoting healthy habits among students, such as proper nutrition and physical activity.
Occupational therapists can work with individuals recovering from surgeries, such as joint replacements or stroke, to regain their functional abilities and independence. For instance, they may provide rehabilitation services focused on improving mobility, self-care skills, and home management tasks. By facilitating a faster and more successful recovery, occupational therapists help reduce the need for extended hospital stays or costly long-term care.
Occupational therapists can deliver care directly to individuals in their homes, assisted living facilities, or community settings. They may provide home safety assessments, recommend modifications or adaptive equipment to facilitate independent living, and train individuals and their caregivers on managing daily activities. By supporting individuals in their preferred environments, occupational therapists can help prevent unnecessary hospitalizations or institutional care.
Occupational therapists are skilled in evaluating individuals’ functional needs and recommending assistive technology or adaptive equipment. They can assess the need for mobility aids, such as wheelchairs or walkers, or assistive devices for self-care tasks, like dressing or eating aids. By prescribing appropriate equipment, occupational therapists enable individuals to maintain or regain independence, reducing the need for costly care services.
Occupational therapists collaborate with other healthcare professionals to ensure coordinated and efficient care delivery. For instance, they may participate in interdisciplinary team meetings, where they contribute their expertise in assessing individuals’ functional abilities and recommending appropriate interventions. By coordinating care with physicians, nurses, and social workers, occupational therapists help streamline services, avoid duplication of efforts, and optimize resource utilization.
Occupational therapists can contribute to the development of innovative programs and conduct research studies that inform healthcare practices. For example, they may develop community-based fall prevention programs targeted at older adults or conduct research on the effectiveness of occupational therapy interventions in reducing hospital readmissions. By identifying cost-effective interventions backed by evidence, occupational therapists contribute to the improvement of healthcare outcomes while minimizing costs.
Addressing Profit-Driven Motives
Occupational therapists can advocate for policy reforms that prioritize patient care over profit. They can join professional organizations and participate in advocacy efforts to raise awareness about the importance of patient-centered care and equitable access to services. By engaging in legislative advocacy, occupational therapists can influence healthcare policies and promote changes that prioritize the well-being of patients. For example, occupational therapy practitioners can advocate for legislation that ensures insurance coverage for essential occupational therapy services, such as mental health interventions or early intervention for children with developmental delays. Simply by being a member of your state or national professional organization, you can help to advocate through member costs.
Occupational therapists can educate the public and healthcare stakeholders about the value and benefits of occupational therapy services. By increasing awareness of the unique contributions and outcomes achieved through occupational therapy, they can help shift the focus from profit-driven models to patient-centered care. Occupational therapists can engage in community outreach initiatives, deliver presentations at healthcare conferences, and collaborate with other healthcare professionals to promote the understanding of their role in improving health outcomes. For example, occupational therapy practitioners can organize community workshops on the benefits of occupational therapy for managing chronic conditions, promoting mental health, or enhancing functional independence in daily life.
Occupational therapists can emphasize evidence-informed practice and demonstrate the effectiveness of their interventions in achieving positive outcomes. By providing data-driven evidence of the cost-effectiveness and improved patient outcomes associated with occupational therapy services, practitioners can advocate for their inclusion in healthcare plans and reimbursement systems. For example, occupational therapy practitioners can assist in the collection of data on patient progress, functional outcomes, and cost savings resulting from occupational therapy interventions. This data can be used to demonstrate the value of occupational therapy services to insurance providers and healthcare administrators.
Even more importantly, occupational therapy practitioners can adhere to ethical principles and prioritize the needs and well-being of their clients over financial considerations. By upholding ethical standards, occupational therapists can maintain a patient-centered focus and advocate for the best interests of their clients, rather than sending a message that more profit can be extracted from patients and therapists.
The work that occupational therapy practitioners do on a daily basis can have an effect on the US healthcare system as a whole, including the perceptions of people who access it. Although OTPs are not considered primary providers such as physicians, nurses, and pharmacists under a medical model, they do work in many of such settings from hospitals to clinics to outpatient centers to people’s homes.
Occupational therapy as a profession provides a unique value to address the barriers in the US healthcare system, which is primarily based on a medical model. Occupational therapy offers a unique approach to care that goes beyond the medical model by prioritizing holistic well-being and meaningful participation in daily activities. Occupational therapists work with individuals to identify their personal goals and interests, and then design interventions to enhance their ability to engage in those activities. By focusing on a person’s abilities, strengths, and goals, occupational therapy promotes independence and overall well-being. This client-centered approach not only improves individual outcomes but also has the potential to address costs and profit-driven issues in the US healthcare system.
By empowering individuals to actively participate in their own care and promoting preventive strategies, occupational therapy can help reduce the need for costly medical interventions and hospitalizations. Additionally, occupational therapists’ focus on enhancing functional abilities and promoting independence can support individuals in maintaining their productivity, reducing healthcare costs associated with disability and long-term care. By emphasizing the value of personalized, goal-oriented care, occupational therapy can contribute to a healthcare system that prioritizes patient well-being over profit-driven models.
- American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001
- Pizzi, M. A., & Richards, L. G. (2017). Promoting health, well-being, and quality of life in occupational therapy: A commitment to a paradigm shift for the next 100 years. The American Journal of Occupational Therapy, 71(4), 7104170010p1-7104170010p5.
- Hay, J., LaBree, L., Luo, R., Clark, F., Carlson, M., Mandel, D., … & Azen, S. P. (2002). Cost‐effectiveness of preventive occupational therapy for independent‐living older adults. Journal of the American Geriatrics Society, 50(8), 1381-1388.
- Graff, M. J., Adang, E. M., Vernooij-Dassen, M. J., Dekker, J., Jönsson, L., Thijssen, M., … & Rikkert, M. G. O. (2008). Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. Bmj, 336(7636), 134-138.
- Nagayama, H., Tomori, K., Ohno, K., Takahashi, K., & Yamauchi, K. (2016). Cost‐effectiveness of occupational therapy in older people: systematic review of randomized controlled trials. Occupational therapy international, 23(2), 103-120.