Perspectives of epilepsy care in the United States

An analysis of epilepsy health care delivery to children and individuals in the United States (US) who are developmentally disabled provides a microcosmic view of the global issues affecting the US health care system. The US is notable for its robust diversity in ethnic, racial, religious, economic, educational, cultural, biologic, and genetic spheres. Consider that within the political boundaries of the US exist the Native American, Inuit, Hawaiian, African-American, European, Indian, Middle Eastern, and Asian cultures. Loci of health care delivery are equally diverse and include urban centers (ranging from elite private hospitals and university centers of excellence to facilities for the indigent), rural locations (including clinics run by the US Public Health Services and exclusive private clinics), and military hospitals (serving either active personnel and their families or eligible veterans). Just as the patient population of the US health care system is heterogeneous, so too are its health care providers. A significant portion of medical care, particularly care for the poor, the developmentally disabled, or individuals living in rural settings is delivered by physicians who received their medical training beyond the shores of the US. In addition, physicians today are also subjected to a variety of non-medical forces that may affect their conduct of medicine. Some are self-employed, private practitioners and as such are compensated on a fee-for-service basis. Others practice under the broad umbrella of managed care wherein there may be financial pressure to do less for patients rather than more. Physicians who practice in emergency room settings (where much of the initial care of individuals with epilepsy occurs) must sometimes practice without much prior knowledge of the patient. In addition, these physicians are infrequently in a position to provide follow-up care. This situation often leads to unnecessary diagnostic testing and too little important after-care. The specter of …