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The true cost of coverage

Here's a quick maths problem for you. A GP in the UK's National Health Service gets around 10 minutes per consultation. And on average, every person turns up to the clinic with 2.5 concerns. How much time does the doctor have to dedicate to each health concern?

The answer is 4 minutes. That's 4 minutes to listen to the person’s problems, assess their symptoms, and organize next steps. That's a lot to fit into the time it takes to make a cup of tea.

That's where online symptom checkers like Ada can make all the difference for GPs. Whether through a smartphone app or a webpage, online symptom checkers encourage people with urgent conditions to seek help right away, while those with milder conditions can manage their health at home. When people hand over their health assessment report in the clinic, it can help me make fast, safe decisions.

But not all symptom assessments are created equal. In some cases, the medical knowledge that powers reasoning engines may not cover the full spectrum of conditions affecting a patient population. That can cause significant problems.

Let's go through a few clinical scenarios that highlight the health costs associated with inadequate condition coverage in symptom assessment tools. All names were changed for anonymity. We'll also get insight from Ada's Health Economic Modelling Scientist, Jan Multmeier, to explain why insufficient coverage can have significant economic impacts too.

The health costs with Dr. Baluch

Case 1: the risk of missed diagnoses

James arrived at my clinic with his daughter Samantha. Sam had been feeling unwell, with a sore throat, fever, and rash over her body. After checking her symptoms using an online assessment, James thought Sam might have caught a common virus but wanted a professional opinion just in case.

After an examination and a closer look at the rash, I suspected Kawasaki disease. Kawasaki disease is one of the most common causes of vasculitis, or inflamed blood vessels, in children. If you catch it early, treatment is usually successful without complications. If not, it can lead to organ damage and life-long health problems.

I like to see parents check their child's symptoms using a safe and accurate symptom assessment before making an appointment. It can help reassure them when there's nothing to worry about, so they can avoid unnecessary visits. But most symptom assessment tools don't cover the less common conditions and may not even cover children's health at all. That's a problem when there is something to worry about.

Sam made a full recovery. But if James had dismissed her illness as a common viral infection because of missing coverage or flawed advice from an app, then the story might have been different. Ensuring broad condition coverage within patient-facing digital health tools is paramount to avoid missing essential diagnoses.

Case 2: complicated diagnostic journeys

Lisa was in her third year of university. She'd been feeling tired and run down for months. She was also experiencing physical symptoms, including chest pains, shortness of breath, and stomach problems. Her symptoms were starting to affect her studies.

Lisa had been to the doctor before and had several tests, including a thyroid check-up. But everything came back normal. When her chest pains became severe, she decided to head to the emergency room, fearing the worst. But they found nothing wrong with her heart or lungs, so they sent her to me for another check-up.

After reviewing her medical history, I asked Lisa if she'd ever experienced prolonged stress or anxiety. She told me she'd been under huge pressure to pass her exams. I explained that mood changes could cause the symptoms she's experiencing. We began exploring options for managing stress and anxiety.

Many of my patients only discover an underlying mental health concern after long periods of suffering from symptoms that seem unrelated. Lisa had no idea that stress and anxiety could take such a toll on her body.

Understanding mental health can be life-changing for people like Lisa, who are losing hope and don't know where to turn. Suppose Lisa had accessed a symptom assessment tool with good mental health coverage and reliable medical knowledge early on. She could have saved herself months of distress and repeated visits to health services.

Case 3: a common problem with many causes

Alyssa had been waking up with a painful and stiff back for months. She found that long days at the office made it much worse. The only thing that helped calm things down was a brisk walk around the block. She'd experienced back pain on and off before, but this time it was starting to affect her sleep, so she made an appointment.

After going through her symptoms and history, I organized some initial tests which suggested inflammation of the spine. She was promptly referred to a specialist who, after conducting further tests including an MRI scan, diagnosed AS.

Alyssa was fortunate. We identified her condition early, which means treatment is likely to be effective. But many of my patients don't get such fast answers. Back pain is one of the most common complaints doctors receive. And it's one of the trickiest to get to the root of because the cause can depend on the person’s age, sex, occupation, pre-existing medical conditions, and more. The underlying problem can be a simple muscle strain or something more sinister and far-reaching.

If someone with back pain takes an online symptom assessment before their appointment, they can hand their assessment report over to me so we can get straight into the details of their symptoms. But assessments must be as broadly applicable as possible. They need to be smart enough to tell the differences between posture-related back pain, acute muscular-skeletal issues, or a by-product of another underlying condition.

The economic costs with Jan

When symptom checkers don't cover conditions that affect the whole population, it doesn't just impact health outcomes. Delayed diagnosis and treatment carry resource implications for entire healthcare systems and wider society.

Mental health disorders, for example, affect about 30% of the global population in any given year. Over two-thirds of those affected won't receive the care they need.ref1 At the same time, mental health disorders cause a serious reduction in life quality due to disability and can be a slippery slope into poverty due to a reduced ability to work.ref2

Back pain also carries a significant economic burden. Let's look at Dr. Baluch's patient Alyssa. Hers was an unusual case in that she received her AS diagnosis quickly. AS is one of a subset of diseases called axial spondyloarthritis (axSpA). On average, it takes 5 to 14 years to diagnose axSpA.ref3 That means multiple visits to the GP, long-term use of pain medication, and several dangerous or unnecessary spinal surgeries. And the later the patient receives a diagnosis, the worse the situation gets, with a higher likelihood of work disability and unemployment and increased medical costs. If axSpA is covered, symptom assessments can save those people from torment while reducing costs for healthcare systems and retaining economic productivity.

Comprehensive coverage can mean better health outcomes for patients and economic benefits to healthcare systems and wider society.

Conclusion

Symptom assessment tools help GPs like me make the most of the crucial minutes I get to spend with my patients. They can also help optimize care journeys, support positive outcomes, and save money and time. But to be effective, it’s essential that they cover as broad a range of conditions as possible.

That's why we're here. We built Ada to transform medical knowledge into better health outcomes for everyone. We're committed to covering as broad a range of conditions and demographics as possible to cater for our global user base. Let's discuss enterprise solutions powered by Ada. Get in touch.


  1. NCBI. “Mental disorders, health inequalities and ethics: A global perspective”. Accessed December 11, 2020.

  2. “Global Burden of Disease and the Impact of Mental and Addictive Disorders”. Accessed December 11, 2020.

  3. “Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review”. Accessed December 11, 2020.

Writer:

Dr. Adel Baluch
Dr. Adel Baluch

Dr. Baluch is our Medical Director, Enterprise.