Over the past few years, I have written a fair number of entries about the US health care system, but I am always uneasy when I “stray” from specific endocrinology issues for fear that some readers will think I am getting “political,” something I work hard to avoid doing. Anyway, apparently I just can’t help myself and I feel the need to comment about the state of things using two recent examples.
The first is a very interesting article that was published in the NYT last Sunday (June 2, 2013). The article, which was on the front page, was entitled, “The $2.7 trillion Medical Bill. Colonoscopies explain why the US leads the world in health expenditures,” and was written by Elizabeth Rosenthal. The article really contained no new information but summarized costs differences around the world for various common medical procedures. The data were staggering. For example, an angiogram costs, on average, $914 in the US and $35 in Canada; a colonoscopy costs $1,185 in the US and $655 in Switzerland. You get the message: we in the US pay top dollar for our medical care and we are none the healthier for it. The article goes on to discuss why things cost so much in the US compared to other places but doesn’t offer any ideas on how to improve things. In my view, none of this would matter much if all our citizenry had easy access to great medical care regardless of their ability to pay, and if we had better outcomes than elsewhere. Anyway, you need to read this article, especially if you are a physician or anyone else who works in health care.
The second is an experience my son and family had a few weeks ago that made clear to me just how dysfunctional our health care system is. I received a telephone call from my daughter-in-law late in the afternoon on the Sunday before Memorial Day. Their son, James, age 4 years (one of my grandkids), fell and split his lip, which was bleeding profusely. They had called their pediatrician’s office, but because it was “after hours,” no one was available to see the child until the next Tuesday. Anyway, they sent me 3 gory i-phone photos. The cut was a very deep one, but did not extend all the way to the inside of the mouth. I recommended they find an urgent care center where it would be easy to put in a stitch or two or stick on a couple of steristrips to decrease the likelihood of later scarring. To make a long story short, they drove around Berkeley and Oakland, CA for 45 minutes until they found an open urgent care center only to be told the facility didn’t do any emergency type stuff, including cut lips. In the end, the family just went home totally exhausted and frustrated. I think James will do fine and the lip will probably heal up with little or no scarring but that is not the point. Our health care system could and should have done better. In this case it wasn’t about costs (the family has health insurance and would have gladly paid out of pocket for care), but rather, easy access to care.
So, what’s my point?
The NYT article and my grandson’s recent medical care experience both make clear, at least to me, that our health system needs fixing. For a number of years I have wrestled with the question of whether we physicians have a moral/ethical imperative to do something about the mess and even if we have the ability to improve things? I am now convinced that unless we do get organized and act to improve things, nothing will change until things get so bad that it will be possible for some charismatic politician to completely overhaul the US health care system (for better or worse). It won’t take as long for this to happen as some people think; the costs for health insurance in the US have been rising at 15-25% per year, and I recently read it is estimated the costs will go up as much as 50% within a year or two. I have no idea how we physicians can drive change but we need to find a way.
There are some rather simple and obvious things we can do right now. For example, we can make sure our patients have easy access to care, weekends, holidays and all. Maybe, the changes will cut into our “bottom lines” a bit, but that is part of what we must accept if we are to meet the obligations we have for our patients. Some changes are easy to effect with little or no increase in costs. For example, when I call a physician’s office I typically get a long message with all the various options. I just love the option to get a prescription refill. Typically, the message says that it will take up to 72 hours to get the refill request completed. In my opinion, that is ridiculous. If a patient just realized they are out of insulin, they can’t wait 3 days to get the next bottle. Sure, they should have been paying attention to their insulin supply, but these things happen. We as physicians must know what our patients are being told by secretaries and other administrators. It is our responsibility.
What can patients do?
If I were a patient seeking a primary care doctor, I would do my best to get into a “system” that is organized such that someone from the group is available 24/7, and that the care system is up-to-date with easy e-mail communication between physician and patient, and with easy patient e-mail access to their medical records (we have that available at our medical center and it is wonderful). I do know that our son and daughter-in-law are going to have a little chit-chat with their son’s primary care doctor pretty soon. I cannot predict how the discussion will go.
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