Its the end of the year
In the artificially created system of healthcare, thousands if not tens of thousands of people are scurrying to get as much of their healthcare crammed into the last few days left in the year. Is this because they need healthcare and there is some seasonal need?
Sadly not – if you live in the United States and consider yourself lucky enough to have health insurance you know that the end of the year is a significant event in the financial calendar of healthcare. Everything resets. What do I mean by that? Well on a personal level it means your deductible and co-insurance resets. It is true for all insurance systems. It even resets for plan administrators in the case of risk assessments in Medicare Advantage plans, Medicare Shared Savings Program (MSSP), and accountable care organizations (ACOs) but that’s the subject for another post.
So for anyone struggling with finances, something even more acute for many in this inflationary economy means you want to get as much “healthcare” (that’s procedures, doctor visits, specialists visits, investigations, drugs, etc) as you can. It is so bad that I hear from many of my clinical colleagues that they deliberately don’t schedule any time off in November or December. Their offices and practices are so busy and they want to help their patients get the care they need without incurring the additional personal expense.
For some it can be worse – with healthcare insurance expiring and financial pressures, especially for the younger members of our community, some drop their insurance during the other annual enrollment period. When faced with the challenges of paying bills, buying food, and other essentials, younger generations cancel their insurance to save money thinking that they won’t get sick or need insurance.
So it was for one young man I know. Fit healthy and working in a relatively low-paid job. The health insurance offered at his work was 15% of his take-home pay and he was already overwhelmed with the cost of rent and food. Balancing his books was already impossible so he like many others his age made the decision to cancel his insurance.
Fast forward to the end of the year and he discovers worms in his stool. Not a medical emergency but something that needs treatment. He still has insurance for the balance of the year so there is now a sense of urgency to find someone to diagnose and confirm if he is infected with a parasite or not and if so what type of parasite so that the right treatment can be started.
Like many in his generation, he has no primary care Physician – he has never had cause to see one, and besides he is new to the area having over here for the job. Calling the insurance number on his card is no help as like so many he gets lost in the automated menu that doesn’t understand him and continues to pump marketing messages into their ‘conversation’.
So he looks up local family doctors and starts calling around. He is told that they don’t treat worms and that he needs to go to the Emergency Room!
Who would say such a thing? Why would somebody say such a thing?
Talking to colleagues who work in the Emergency Room a common complaint is the overutilization of a resource that is designed to treat emergencies by patients that don’t require emergency care. But that’s a whole other problem that requires addressing.
Knowing that emergency rooms are not the best choice he calls urgent care centers. They say the same thing, they don’t treat worms and advise him to go to the emergency room!
Again. Who would say such a thing? Why would somebody say such a thing?
What Would You Do?
Now feeling isolated and concerned he decides to go to the local emergency room in the hope that this is the right choice.
What a disaster unfolds here. Seen in triage where they ignore the worms. You guessed it they don’t treat worms in the Emergency Room. But anyone showing up reporting symptoms of abdominal discomfort, real or in this case likely imagined, now he gets categorized as Abdominal Pain requiring rule out of all sorts of potential Clinical conditions. An IV line was inserted, and blood was taken for sending to the laboratory. In comes the billing staff and hand him his estimate for care and as it is so quaintly described
“Your patient liability – $2,200″
Liability is right. That equates to more than a month’s salary!
Terrifying – think about it in terms of your own financials and suddenly be presented with a bill that exceeds your monthly take-home pay. Oh and this was “with” insurance. With the widespread high-deductible plans these are bills we are all responsible for.
All this is enough to scare anyone and in this case enough for him to want to run out of the Emergency Department. Not before he recovered the picture ID that is now nicely stored in patient accounting and will no doubt be used to chase him down for the charges. Charges incurred because of the litigious nature of our society have forced their medical profession to practice highly defensive medicine. The faintest wife of a clinical issue demands a full expensive workup to rule out the possibility of a clinical problem.
In any reasonable system a clinical assessment that showed a young, fit healthy individual in no physical distress, no temperature, no Clinical symptoms or signs, and complaining of worms would not be suspected of any acute clinical condition and sent home and told to call or come back if any symptoms develop. Not here in the United States
No resolution to the clinical problem, just the stress to wait for a bill that is unaffordable for a bunch of Clinical activities unnecessary and certainly not wanted.
The system is working as designed but its failing in so many areas
My wish for this holiday season is that everyone comes together to find real solutions in all areas. Those in government and positions of responsibility have to take a leadership role in solving our crisis. The costs are unsustainable and we are not getting the healthcare value we all deserve and need
