While medical technology in the US may be among the top in the world, delivery of these advances to the people who need it is a different story. As doctors, we know the right test or medicine a patient needs, yet we also know that having the patient get it can be an obstacle course or a never-achievable reality.
Just because a patient has healthcare insurance doesn’t mean that they will be able to get what they need. Insurance companies have created mind jarring discrepancies in care and the gulf is widening. Unless you have the “right” insurance plan, you may not be able to afford care. Most plans now carry huge deductibles and coinsurances. Forget about Medicaid plans, which many specialists do not even accept. I’ve seen patients wait months and months to see an orthopedist or have no psychiatrist in the state available to see them. And if a patient doesn’t have insurance, a simple visit to the ED can approach $100,000.
Healthcare, even for the insured, has become unaffordable for many. In fact, it is the leading cause of bankruptcy in the US. Many patients have to face the option of paying for healthcare that may cause financial disarray in their homes or going without and suffering the consequences. I’ve seen older adults decide which one of their medications they can afford to take and which ones they will hold off on taking until they meet their deductible.
We are practicing in a dysfunctional system, and this is the real cause of physician burnout. We know what will help our patients, but we don’t always know how to give it to them. Too many third parties are standing in our way. Here are a few tips to help patients afford the care we recommend:
- Use generics when possible. When we prescribe medications for patients, we try to give them the best one for their condition. However, the one we prescribed is often not covered by the patients’ insurance. Some patients call and tell us, while others just don’t fill the prescription. The best medicine is the one that the patient will take. Generics can often be substituted for more costly name brands. If a brand is more appropriate, many pharmaceutical companies offer discount cards. Of course, we don’t have time to go coupon hunting, but we can direct patients to the manufacturer’s website to see what help is available.
- Think of alternatives. Most people cannot afford to pay for an MRI out of pocket. Is there a test that can substitute? Maybe it is not the best test but it can give some useful information. Maybe a trial of NSAIDs will help the patient’s pain. Some care is better than no care.
- Refer the patient to social service programs. Many patients don’t know how to get medical coverage. It is confusing enough for those who deal with it on a daily basis. Most hospitals have a department that can help. Referring a patient there may help them to get insurance or charity care. As a doctor in private practice, I understand the time constraints on most of us. However, just having a phone number available to give to patients can make a huge difference for some.
- Fight the system. None of us has time to play politics, but it seems that much of the healthcare system is now a political playing field. Support candidates who can make a difference. If possible, consider running for office. Most decisions are now out of the hands of physicians, yet we are the ones most affected by those decisions. Encourage patients to join the cause, whether it’s by calling the insurance company to fight for care or by writing letters to local politicians. Passivity will only continue the downward trajectory the system has been undergoing.
As physicians, we are called to care for the health of our patients. We all know how difficult this is in our current system. However, to do nothing is to do harm. If we don’t advocate for our patients, who will?
