I saw a patient today and looked back at a previous note, which said the following: \”stressed out due to insurance.\” It didn\’t surprise me, and I didn\’t find it funny; I see a lot of this. Too much. This kind of thing could be written on a lot of patients\’ charts. I suspect the percentage of patients who are \”stressed out due to insurance\” is fairly high.
My very next patient started was a gentleman who has fairly good insurance who I had not seen for a long time. He was not taking his medications as directed, and when asked why he had not come in recently he replied, \”I can\’t afford to see you, doc. You\’re expensive.\”
Expensive? A $20 copay is expensive? Yes, to people who are on multiple medications, seeing multiple doctors, struggling with work, and perhaps not managing their money well, $20 can be a barrier to care. I may complain that the patients have cable TV, smoke, or eat at Taco Bell, but adding a regular $20 charge to an already large medical bill of $100, $200/month, or more is more than some people can stomach. I see a lot of this too.
Finally, I saw a patient who told me about a prescription she had filled at one pharmacy for $6. She went to another pharmacy (for reasons of convenience) to get the medication filled, and the charge was $108. I could see the frustration and anger in her eyes. \”How do I know I am not getting the shaft on other medications?\” she lamented. I told her that I see a lot of this.
Then I started considering how many doctors, nurses, and hospital administrators are \”stressed out due to insurance,\” and I laughed. I think the number of those not stressed out would be far easier to count. In this blog I have recounted the overall cost the insurance situation takes from my own practice, and my own psyche. I can\’t do it justice in a single post, it takes a huge toll on those of us in it. The cost is high.
So what is the overall cost of a bad system? Sure, the system itself uses money poorly and dumps buckets of money on things that have no impact on the health of patients. Sure the system encourages doctors to not communicate, not spend time with patients, and to spend more time with the notes than with the patient. But what is the toll of this toll? What is the toll that simply having an insane system that demands huge sums of cash, yet does not give back a product worthy of that cost? What is the toll of people suspicious that they are being gouged at the pharmacy, hospital, or doctor\’s office? What is the cost of having a healthcare workforce that goes home more consumed by frustration about the system than by the fact that people are sick and suffering?
Our system is very sick, and the fact that it is so sick makes me sick. It makes a lot of us sick.
I see a lot of that.
I was kind of stunned recently when plavix went from 390 to $530 for a 90 tablet refill.
My earliest Rx in '05 was around $300 for 90 tables. Part D has an uncertain influence
here, but I checked the Henry Schein site and their price was $730 for 90 tab!!?
Still has 2-3 yrs to run on the patent but this is getting ridiculous. Wonder what the
last year before off patent price will be and where the generic will come in at.
Somehow, this post made me feel better. It just rings so true–the confusion, the expense, the wondering if you're picking the right one and then being afraid it won't cover you for what you need in the end. Argh! Sometimes it seems like there is no solution. Thanks for the commiseration.
Great post. How can you encourage patients to adhere to preventative care (i.e. colonoscopy, mammograms, etc) when they think it's really just a ploy to gain more RVU's and copays?
Most know already that it's a good thing – and it helps that I personally am not profiting off if them. But the real way to address this issue is to change the payment system.
I am very frustrated with the system as well. I often start thinking about getting out of it completely and opening a cash practice, which could be near suicidal as a specialist. The entire insurance industry is completely screwed up. They serve no real purpose other than to skim money out of the system. At the same time our country cannot accept the absolute reality that we cannot provide an unlimited amount of healthcare to an unlimited amount of people for a limited amount of money. We insist that human life cannot be given a dollar value, so we then spend an unlimited amount of money on it, ultimately money that is borrow from the Chinese government.
Its a pickle.