I think freedom is critical in optimizing people's health care. For patients to be able to choose their own pharmacist, their own hospital and their own physician is as important as it is rare.
Unfortunately by relying so heavily on health insurance and the inflated prices related to that, most patients are financially pressured into using a mail-order pharmacy service. From personal experience I can tell you, many of the operators for these places lie.
When I called to check on the status of a prescription I mailed in for my son I was told that I had not received it because they had called the doctor's office and the doctor personally canceled it. I was never given an answer on how that was possible since I was the ordering doctor and didn't remember that phone call.
My office has been called by these mail order pharmacies on several occasions to notify me that a patient specifically requested that I change a medication to one which would save the patient (and more importantly, the pharmacy) a lot of money. When my nurse would call the patient to confirm this, the patient would not be able to remember that phone call.
Either both I and my patients have extremely poor memories or these mail order pharmacy employees could give lawyers a run for the money ethically. If you have an insurance that provides prescription benefits, you should be able to use those discounts at the pharmacy of your choice.
A local pharmacist can be an important member of a patient's health care team. They establish a relationship with their customers and can provide important advice on appropriate over the counter products to take with an individual's prescription drugs, they can advise your physician on possible drug interactions, and they can provide education on the best and safest ways to use the medications.
Only having one local hospital, the choice of hospitals is not a large issue for most of the residents of Henry County. It can come into play when your doctor needs to transfer you from Henry County Memorial Hospital to one in Indianapolis. Due to the large expenses incurred from a hospitalization, a patient that is not independently wealthy will go to a hospital where the insurance will cover the expense.
Your primary care doctor may have a preferred hospital to send you to based on where he trained or based on previous good experiences. Overall I do not see this as a big problem as my experience has been good in dealing with doctors at all the major hospitals in Indianapolis.
The biggest obstacle to optimal health care is the restrictions placed by insurance companies on which doctor the patient is allowed to see. In the "good old days" this decision was left entirely up to the patient and it worked well from everyone's perspective. That is until the insurance companies realized they could make more money by changing the status quo.
The health insurance companies reasoned that since they paid the bills, they could control which doctors the patients went to see. Just as they do with pharmacies, the choices are based almost entirely on the cost to the insurance companies. The doctors who were willing to discount their prices were "preferred providers" to them. Quality of care didn't enter into it. This meant that instead of allowing the patient complete freedom to choose their doctor, choosing a "non-preferred" doctor was now a more expensive option than a "preferred one.
While with most insurance the customer has certain rights in choosing who repairs their car or house after an insurance claim, not so with health insurance. The insurance company can elect to not pay anything if you exercise your freedom in choosing a pharmacist, or hospital, or even a doctor who is not a "preferred provider".
Some might argue that such is the prerogative of the health insurer since they are paying the bill. I would suggest that health care is different, that there is an intimate relationship between a patient and a doctor and that to be able to receive optimal health care it is necessary to have a trusting, ongoing relationship with a "patient preferred" physician.
I believe that health insurance policies should of necessity be required to offer the same benefits and services to whomever the patient prefers in regards to their choice of pharmacy, hospital and especially physician. The patient's freedom in choosing their health care providers should supersede the insurance company's right to dictate who they will provide benefits to on behalf of the patient.
2/16/07
COMMON SENSE ISN'T
I think that common sense isn't anymore. Maybe it never was. Everyday I see examples of behaviors that seem like it should be self-evident to be irresponsible, disrespectful, or rude. Three common examples that are related to health care come to mind.
It should be common sense when you are driving to pull over when an ambulance with sirens and flashers going is within view. It seems to me that in New Castle, the only time people consistently pull off to the side of the road is when there is a funeral procession in progress. I suppose that it is comforting to the patient in the ambulance knowing that if he dies because of a delay in getting to the hospital caused by drivers not pulling over, he will at least get that courtesy in a few days during his funeral procession.
It should be common sense to treat authority figures with respect. If you are in a professional setting, you should address professionals by their titles regardless of whether or not you know them socially. You wouldn't (or rather shouldn't) call a judge by his first name in court, or a pastor by his first name in church, or a policeman by his first name when he's in uniform and you shouldn't call your doctor by his name in his office or the hospital.
Some doctors don't mind having their patients address them by their first name. Certainly that is their prerogative, but it just further erodes the status of physicians in society. The lawyers and media are doing a good enough job on their own of this and don't need the extra help.
Now I'm not an uppity guy by any means, but I like to be shown the respect I've earned by being addressed as a professional. I'm even OK with "doc", just ask my wife. So if you see me at Wal-Mart and want to say "Hey Keith, how are you?" that's fine, but in the office or hospital keep it professional.
It should be common sense to turn off your cell phone when you are in a doctor's office. While most people will turn them off in a movie theater or during a church service, I would argue that these same people do not see anything wrong with leaving their cell phone on during the entire time that they are in the doctor's office.
Too often people are talking on a cell phone why a nurse is checking vital signs or asking them questions about their health. This creates an unacceptable and avoidable chance for errors as well as causing a delay in making the chart ready for the doctor to evaluate the patient. A person talking on the phone when the doctor enters the room or who answers a cell phone while the doctor is present is telling his physician the type of patient he is going to be. Self-absorbed and non-compliant are some of the unappealing words that come to mind.
Now most people have voice mail and there is no good reason to leave a cell phone on during a doctor visit. Very, very few situations exist where a phone call can't be returned half an hour later or longer. Believe it or not, 15 years ago when most people didn't have cell phones, not many lives were lost by patients not being immediately accessible by cell phones during an office visit. If you are waiting on a phone call that is of such importance that you are willing to interrupt your evaluation by your physician, I would suggest you need to reschedule your visit.
While it is debatable that good manners are a thing of the past, it is clear to me that things that should go without saying (like pulling over for ambulances, calling a doctor by his title, and turning off cell phones during office visits) can't. So at the risk of alienating people, I am saying what needs to be said (or more accurately writing what needs to be written (and you are reading what needs to be read)).
It should be common sense when you are driving to pull over when an ambulance with sirens and flashers going is within view. It seems to me that in New Castle, the only time people consistently pull off to the side of the road is when there is a funeral procession in progress. I suppose that it is comforting to the patient in the ambulance knowing that if he dies because of a delay in getting to the hospital caused by drivers not pulling over, he will at least get that courtesy in a few days during his funeral procession.
It should be common sense to treat authority figures with respect. If you are in a professional setting, you should address professionals by their titles regardless of whether or not you know them socially. You wouldn't (or rather shouldn't) call a judge by his first name in court, or a pastor by his first name in church, or a policeman by his first name when he's in uniform and you shouldn't call your doctor by his name in his office or the hospital.
Some doctors don't mind having their patients address them by their first name. Certainly that is their prerogative, but it just further erodes the status of physicians in society. The lawyers and media are doing a good enough job on their own of this and don't need the extra help.
Now I'm not an uppity guy by any means, but I like to be shown the respect I've earned by being addressed as a professional. I'm even OK with "doc", just ask my wife. So if you see me at Wal-Mart and want to say "Hey Keith, how are you?" that's fine, but in the office or hospital keep it professional.
It should be common sense to turn off your cell phone when you are in a doctor's office. While most people will turn them off in a movie theater or during a church service, I would argue that these same people do not see anything wrong with leaving their cell phone on during the entire time that they are in the doctor's office.
Too often people are talking on a cell phone why a nurse is checking vital signs or asking them questions about their health. This creates an unacceptable and avoidable chance for errors as well as causing a delay in making the chart ready for the doctor to evaluate the patient. A person talking on the phone when the doctor enters the room or who answers a cell phone while the doctor is present is telling his physician the type of patient he is going to be. Self-absorbed and non-compliant are some of the unappealing words that come to mind.
Now most people have voice mail and there is no good reason to leave a cell phone on during a doctor visit. Very, very few situations exist where a phone call can't be returned half an hour later or longer. Believe it or not, 15 years ago when most people didn't have cell phones, not many lives were lost by patients not being immediately accessible by cell phones during an office visit. If you are waiting on a phone call that is of such importance that you are willing to interrupt your evaluation by your physician, I would suggest you need to reschedule your visit.
While it is debatable that good manners are a thing of the past, it is clear to me that things that should go without saying (like pulling over for ambulances, calling a doctor by his title, and turning off cell phones during office visits) can't. So at the risk of alienating people, I am saying what needs to be said (or more accurately writing what needs to be written (and you are reading what needs to be read)).
2/10/07
YOU'RE IN GOD'S HANDS
I think people need to rethink health insurance. Like most insurance, it should be to help pay for unmanageable expenses which in health care include surgeries, hospitalizations, and unfortunately even emergency room visits. Somewhere along the way however, many people became spoiled and became used to health insurance paying for office visits and medications as well as the catastrophic expenses.
There are a host of reasons health insurance costs as much as it does, (the CEO of Anthems $42 million dollar bonus last year comes to mind). The bottom line is that the more any insurance covers and the lower its deductible, the more it will cost. Just think for a moment what would happen to your auto insurance premium if it had to cover oil changes, tune-ups, and repairs.
It is very natural for people to want to get the most for their money (looking at people eat at a buffet should illustrate this nicely). If you feel you have paid greatly for your health insurance, you want to be able to use it freely. You want to be seen for even minor complaints, you want the most modern tests, and you want to see the specialist. I would too.
That is why the medical savings account (MSA) makes the most sense for most people. You put money in just like you pay for traditional health insurance premiums and money is paid out to cover routine expenses with the insurance company covering catastrophic expenses. If you have few health care expenses from good lifestyle choice, good genes, or just flat out good luck, the majority of the money stays as yours.
Your health insurance is a contract between you and your insurance company. If a doctor has signed a contract with the insurance company they become a participating provider and agree to abide by all the insurance companies rules when it comes to referring patients to other doctors, prescribing medications, and obtaining prior authorization to order expensive imaging tests like an MRI or CT scan. Your doctor no longer works just for you; he also works for the insurance company.
By not being a participating provider with any insurance company I am able to be a complete advocate for my patients. I have no inherent conflict of interest when it comes to referring patients, prescribing medications, or authorizing needed tests. I also greatly limit my overhead cost by not having to hiring additional personnel to constantly be on the phone with the insurance company, by not having a delay in reimbursement from the insurance company, and by not having extra paperwork that being a participating provider entails.
These cost savings are why I can charge so little compared to other doctors. The majority of simple visits cost less than most patients' monthly cell phone or cable/satellite television bill. In many cases it is very close to patients' office co-pay charge. If you have a $30 co-pay you are $30 out every time you visit the doctor. If your insurance reimburses you 50% on doctor visits that are not participating providers, you are out $21 of a $42 office visit charge. The only drawback, which is necessary for me to make this work, is that you need to pay the $42 at the time of service and wait for you insurance company to send the portion they pay back to you.
Obviously this relatively small expense can be a burden to some. Generally the people with health insurance have good jobs and can afford an office visit. The people without health insurance are punished when they incur large expenses and when they are forced to pay the inflated charges at most doctors' offices as I explained in a previous article. This can work if physicians do their part and charge a reasonable and fair amount for an office visit.
For health insurance to become affordable we will need to rethink its role, especially in primary care. Health insurance is clearly indispensable when it comes to covering the expense of catastrophic illnesses and injuries. It should not be expected to cover smaller, manageable office visit expenses. If you think it should, then you should not complain about the cost of health insurance.
There are a host of reasons health insurance costs as much as it does, (the CEO of Anthems $42 million dollar bonus last year comes to mind). The bottom line is that the more any insurance covers and the lower its deductible, the more it will cost. Just think for a moment what would happen to your auto insurance premium if it had to cover oil changes, tune-ups, and repairs.
It is very natural for people to want to get the most for their money (looking at people eat at a buffet should illustrate this nicely). If you feel you have paid greatly for your health insurance, you want to be able to use it freely. You want to be seen for even minor complaints, you want the most modern tests, and you want to see the specialist. I would too.
That is why the medical savings account (MSA) makes the most sense for most people. You put money in just like you pay for traditional health insurance premiums and money is paid out to cover routine expenses with the insurance company covering catastrophic expenses. If you have few health care expenses from good lifestyle choice, good genes, or just flat out good luck, the majority of the money stays as yours.
Your health insurance is a contract between you and your insurance company. If a doctor has signed a contract with the insurance company they become a participating provider and agree to abide by all the insurance companies rules when it comes to referring patients to other doctors, prescribing medications, and obtaining prior authorization to order expensive imaging tests like an MRI or CT scan. Your doctor no longer works just for you; he also works for the insurance company.
By not being a participating provider with any insurance company I am able to be a complete advocate for my patients. I have no inherent conflict of interest when it comes to referring patients, prescribing medications, or authorizing needed tests. I also greatly limit my overhead cost by not having to hiring additional personnel to constantly be on the phone with the insurance company, by not having a delay in reimbursement from the insurance company, and by not having extra paperwork that being a participating provider entails.
These cost savings are why I can charge so little compared to other doctors. The majority of simple visits cost less than most patients' monthly cell phone or cable/satellite television bill. In many cases it is very close to patients' office co-pay charge. If you have a $30 co-pay you are $30 out every time you visit the doctor. If your insurance reimburses you 50% on doctor visits that are not participating providers, you are out $21 of a $42 office visit charge. The only drawback, which is necessary for me to make this work, is that you need to pay the $42 at the time of service and wait for you insurance company to send the portion they pay back to you.
Obviously this relatively small expense can be a burden to some. Generally the people with health insurance have good jobs and can afford an office visit. The people without health insurance are punished when they incur large expenses and when they are forced to pay the inflated charges at most doctors' offices as I explained in a previous article. This can work if physicians do their part and charge a reasonable and fair amount for an office visit.
For health insurance to become affordable we will need to rethink its role, especially in primary care. Health insurance is clearly indispensable when it comes to covering the expense of catastrophic illnesses and injuries. It should not be expected to cover smaller, manageable office visit expenses. If you think it should, then you should not complain about the cost of health insurance.
Subscribe to:
Posts (Atom)