The Problems of Health Care... a series
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.
http://www.realsimple.com/health/first-aid-health-basics/what-to-ask-your-doctor/how-to-complain-about-your-doctor
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