I know everyone has an opinion on what priorities should be and where money can be saved. I could go on for hours with extensive details of what should be changed about inpatient care because I spent more than twenty years as a nurse, mostly in the hospital. The place change needs to occur first, however, is entry into the system.
Many people, most of them uninsured or on Medicaid, use the Emergency Room in place of a primary physician. A twenty-four-hour government-funded triage service could direct patients to the most appropriate location for care. Someone with chest pain or suddenly slurred speech would have an ambulance dispatched to their location. Broken leg or cut that needs stitches? They go to the nearest open Immediate Care Center. If they don’t have a car a taxi is sent, not an ambulance, and they are billed later. An ear infection or Strep throat? Give directions to the nearest drugstore- or grocery-hosted clinic that’s open if it’s urgent, or the name and number of a physician that has agreed to leave appointment slots open the next day if not.
If they need a pregnancy test they are given directions to the nearest “Everything’s a Dollar”-type store. And it’s not an emergency. An ambulance ride costs about $600 in my area, and an Emergency Room visit is usually your entire deductible for the year if you have insurance. God only knows what it is if you don’t. But if you have Medicaid both are free, so patients roll into Emergency Rooms via ambulance complaining of nausea and requesting pregnancy tests while worried parents with lousy insurance wait several days to take a child to the ICC after a fall, praying it’s not a break that will also break the bank.
Selecting a primary care doctor should not be so difficult, either. After all, odds are if you are ill enough to be admitted to the hospital your own doctor won’t even see you. Most PCPs use “hospitalists”, doctors who only see patients in the hospital, not in the office, when their patients are admitted. The very antithesis of continuity of care, don’t you think? Although I can see why they do it. Most established doctors don’t take new patients. They hardly have the time to see the ones they already have. And even those who are accepting new patients won’t take patients who need to be seen more frequently than twice a year. I found that one out the hard way.
Nurse Practitioners and Physician’s Assistants should be used more frequently. Unfortunately, what they can legally do varies widely from state to state, and my state isn’t making good use of this valuable resource. Likewise, they are not making the most of computerized medical records, which could remove a huge burden. Some systems give patients access to their own records and some don’t. So I can get anything I need from my neurosurgeon, but in order to have forms filled out or to get copies of medical records from my PCP I have to make an appointment and go to the office.
Many insurance companies are rewarding insured patients for healthy living, like having an annual checkup or attending wellness seminars. But it’s starting to cross the line from rewarding the good to punishing the bad. Should health insurance companies charge higher premiums to people who are overweight? To people who have high blood sugar or high cholesterol? To those who don’t exercise at least three days a week? I’m all about rewards. How about if health insurance covered your gym membership? But I suspect punishment, not reward, will soon be commonplace.
Then there’s medication. I can’t even count how many times I’ve seen patients admitted to the hospital just a couple of weeks after they’ve been discharged. They are there because their disease process is out of control. Why? Because they haven’t been taking the medications the doctor prescribed when they were discharged. Why? Because they can’t afford them. I’ve seen people in line ahead of me at the pharmacy walk away without their medications because they simply didn’t have the money. I’ve done it myself. If it’s a choice between keeping the heat on in the winter and taking blood pressure medication I’ll skip the medication every time. And those are choices no one should have to make. There are better ways to run the healthcare machine in this country.
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