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My focus over the past four months has been the cost and delivery of diagnostic healthcare in America… trying to understand the basis for the high cost on the one hand... and the poor services on the other.
Getting to the poor services first... I am focused on diagnostics here... diagnostic imaging, blood tests, tissue analysis and so on. There are several aspects of quality that should be considered...
· The time necessary to book a test
· Having to go through a primary care or specialist physician in order to book a test
· The time to be tested from the moment one enters the facility
· The quality of the test itself…
o In blood tests the way the sample is taken by the phlebotomist
o The manner in which the blood or other sample is handled and protected
o The positioning of the patient for the image
o The protocol chosen and implemented for the imaging
o The analysis of the test… imaging, blood or other
· The time it takes for the report to be communicated to the referring physician and the patient
· The ownership of the medical data; where it is stored; its availability over time
There are failures in each of these parameters and more. Patients report being verbally abused by administrative and medical staff. They often report a lack of facilities, appropriate apparel, and decency. They complain about questionnaires that are too long; not kept from one visit to the next; about much of the information having already been sent by the referring physician.
Why are these conditions being accepted by the patient… because historically they have not had an acceptable alternative. Their insurance company or physician has made the appointments and require the use of specific clinics. No alternatives are apparent to the patient.
The second area that is a serious impediment, to good care, is the cost of the test itself. Most patients depend on their insurance companies to pay for the test. But in nearly all cases, there is a ‘co-pay’ required in order to have the test done. Depending on the test, this could be well into the hundreds of dollars. Incremental tests could be extremely costly, and once the annual maximum on the policy is reached, the costs are so debilitating that many patients don’t have the test, or wait until the next annuity.
The many patients who don’t have health insurance are on their own relative to testing. They are cash payers, but are offered at ‘Chargemaster’ pricing… the list price of the hospital. They are rarely offered the ‘discounted-for-cash’ pricing. They also don’t realize that they can negotiate almost any quoted price… as long as it is done before the procedure. In many cases, the patient is paying three to five times the cash price… or more!
The discounted-for-cash price is an important issue in diagnostic medicine. This is a price that is negotiable when the patient has alternatives… and time. In emergent situations, it is almost impossible to bypass the Chargemaster price, the insurance co-pay and so on. In this situation it is important to have ‘catastrophic’ health insurance. Below is a general description of this type of insurance.
In combination with a ‘health savings account’ (HSA), patients can save enormous amounts for their healthcare compared to what they are paying today through their insurance programs… private or employer based. Depending on the patient’s income levels, the HSA, which is a pre-tax savings account, can reduce health costs by a level commensurate with her tax rate. The HSA is explained below.
It would be interesting if employees could convince employers to option them the ability to take an annual cash replacement for their medical insurance… and stop paying the monthly deduction… saving them up to $10,000 a year in out-of-pocket insurance costs… for which they will still have to pay co-pays! The reduction could go directly into their health savings account.
Beyond the idea of the HSA and the potential of negotiating lower diagnostic costs (up-front)… here are a couple of other ideas on how to save healthcare costs
· Reduce one’s risk of health problems
o Exercise regularly (30 minutes a day at a heart rate of 120BPM… a brisk walk for example)
o Reduce calorie intake to a targeted amount, replacing hunger with water
o Wash hands regularly and avoid situations where one has to interface with sick people
o Quit smoking and/or avoid contact with people who are smoking
o Avoid sugar and sugar replacements to reduce the potential of diabetes
o Reduce one’s stress… measure it with a smart phone app… set targets
o Improve sleep habits… measure it with a smart phone app… set targets
· Choose a General Practice physician who offers concierge services. These services are often not expensive, and give better access and annual check-ups
· Have an annual check-up; have routine testing done based on pre-disposition analysis by the GP
· Ensure all vaccines are up-to-date to avoid many diseases, including the flu
· Keep automobile insurance up-to-date with medical coverage (a cheap catastrophic insurance). Keep the car well serviced… the most expensive preventative maintenance is ‘that which is not done’
There are many other ways to avoid health costs… particularly if they are started early with children. Don’t let them get into bad habits… sedentary life-styles, over-eating, dependence on fast-sugar foods and drinks, brushing teeth twice a day, washing hands, staying home when sick, staying away from sick people and so on.
Relative to the issues at the beginning of this post… poor services. Understand that there is no need to put up with any of the issues listed. We all have choices we can make… but always register complaints with the management. If they don’t know how you are being treated, they can’t react. There are many websites where comments can give you and others a heads-up about poor service… and especially good service. These generally are in the USA… but they exist in Canada and other areas in the world.