Recently when New York Times columnist and author Tara Parker-Pope wrote about the exceedingly overspent health care industry, it got me thinking. In her piece she cites a number of causes and the corresponding exorbitant amounts of overspending in the name of "health care." As an advocate of health and wellness from a holistic standpoint, and as a physician, this article immediately brought several points to my mind.
Looking at each of the areas mentioned in the column regarding excess health care spending, here's my take on what's going on and how we really ought to be tackling the issues at hand.
Unnecessary Services: $210 Million
The concept that "more is better" has been around forever. Much like early settlers incessantly seeking more land, this same idea spills over into our health system. Many Americans seem more concerned with receiving "more" tests that we do not seem to care whether or not the medical care is even relevant to our getting "better." Both patients and doctors want these tests due to fear--patients want every test possible to be run just in case, and doctors want to avoid any potential for malpractice claims.
Consider Ms. Parker-Pope and her daughter's sprained ankle. Initially, she got every test recommended. Why was she so willing to go through all of this? Perhaps because she had insurance -- the nameless, faceless medical credit card of sorts -- so she need not assess the true necessity of her daughter's medical treatments. It becomes feasible to run every test under the sun, instead of using tests specific to the nature of the injury. Although she finally put a stop to the nonsense, what about others who are going through the same thing? While Parker-Pope got her daughter out of this hopeless cycle, others are continually put through the wringer by insurance company requirements.
In the same way that "more" seems better to us, "new" is equally as attractive. In fact, though there may be inexpensive generic drugs or affordable and natural over-the-counter alternatives, most patients opt for whatever the health care practitioners and the insurance companies prescribe. This is because they don't have to pay out of pocket for the care. Some of these unnecessary prescribed treatments may even be detrimental to their health or have risks related to them. Unfortunately, when health care is looked at with a "more is better" attitude, the potential for risks is overlooked in the name of fear from both patient and provider.
Inefficiently-Delivered Services: $130 Billion
Let's look again at the example of a simple sprained ankle. It went from a sports medicine specialist, to a pediatric orthopedic doctor, to a rheumatologist, to an eye specialist. All this indicates one thing: practitioners covering their bases. You can bet that if anyone missed a diagnosis or failed to explain something, the column might have been about incompetent practitioners rather than inefficient health care spending. For this reason, practitioners are willing to continue running more tests than necessary to avoid any sort of costly malpractice issues. The testing is merely designed to avoid these major malpractice suits that are now so common in our society and is a prime example of the medical community treading carefully.
Though the doctors and the patient's mother (at first) were reluctant to do anything differently than the system prescribed, the child had the good sense to call them on it. Still, the motivation behind testing, testing and more testing is clearly a cautionary measure. Can you blame them? The threat of unhappy patients and a potential lawsuit perpetuate the "more is better" system currently used by health care providers because of insurance company requirements.
Excess Administration: $190 Billion
The simple truth is that what appears to be "excess administration" is really an issue caused by the use of insurance. The costs associated with using insurance don't just stop at when the insurance card is presented -- in fact, this is where a lot of it begins. Each little task that goes along with processing that little plastic card is translated into more expenses. The provider is now spending money to have someone that verifies insurance coverage via phone or computer, ensures pre-certification requirements for tests and office visits, manages referrals, and processes claims. All of this costs money -- and it doesn't end there. When insurance companies and practitioners don't see eye-to-eye, doctors have to fight to prove their patients need the prescribed care that has been denied.
The expenses keep piling on with each time a provider has to pay someone to process the case, operate equipment, and follow a system of protocol, keeping compliant with all the rules set forth by the government and insurance companies.
Prices That Are Too High: $105 Billion
The number of dollars in profits reported by insurance companies is astoundingly high, especially when you look at how little reimbursement actually goes to the provider at the end of it all. Doctors and hospitals only see a small percentage of the premium dollars. On top of that, health care reform has recently kicked in and requires now that some of those premium dollars be returned to employers. But one major problem remains: The average health care consumer, i.e. you and I, are oblivious to what it actually costs to deliver services and what a reasonable fee to providers would be. We know how much we weigh, what our good-to-bad cholesterol ratio is and our blood pressure... but we fail to realize that most encounters in the health care system truly cost about the amount of a moderately-priced pair of shoes. Moreover, we continue to go for new and expensive drugs and tests just because... well, they are available, and we don't have to pay for them anyway so why not just err on the side of leaving no stone unturned.
Missed Prevention Opportunities: $55 Billion
Our system doesn't pay for wellness, it pays for sickness, and sadly, it only pays when there is a diagnosis. The unfortunate truth is that preventive wellness comes only through diligence and discipline, something that many Americans shy away from because it's harder than a trip to the doctor. Our medical system keeps on feeding into it by underscoring the importance of care only after it becomes necessary. Just like the myriad other choices we have in life, people choose either wellness or sickness, and our current health care system is pushing them toward choosing sickness.
The overwhelmingly gloomy fact is that our insurance plans largely do not support the treatments of complementary practitioners like acupuncturists, naturopaths or Ayurvedic specialists, to name a few. Chiropractic care is only now beginning to come into the mainstream medical system of care, albeit ever so slowly. Who knows if hypnotherapy and energy medicine will ever be taken seriously enough that it could actually help save the billions being erroneously spent on health care? Recent gains of cost-free testing for women do not equate to true prevention. It continues along the same vain of early disease detection. Prevention begins only when individuals begin to take the responsibility of partaking in choices that keep them away from the doctors, hospital and sickbeds. That starts with fitness activities and food choices that promote wellness along with partnerships with practitioners that teach wellness strategies and mindset.
Fraud: $75 Billion
I can relay so many cases where a patient has stormed off, upset with me because I did not succumb to their request to fake their diagnosis. Why would anyone do that? So an insurance company would foot the bill. Yes there are criminal providers, however this is not much more different than the millions of mortgage applications that went through with people lying about their circumstances. What did that do for us? It created a national housing crisis that we are still paying for till this day. Which comes first? Providers lying to get undeserved payments or patients asking providers to lie so they do not shoulder out-of-pocket expenses?
People need to fess up to reality and if there is no diagnosis then just say thank you and sacrifice that cost of a pair of shoes and pay the provider.
There is only one way to begin chipping away at the exorbitant cost of health care in America. That is by each and every individual adopting a new and different mindset to control spending. This includes those of us who write daily about health issues. We all need to realize that every dollar spent by our government is our own hard-earned dollar that we give to the government through taxes. By being good stewards of our own bodies we become good stewards of our own and everyone else's dollars. Americans need to understand that health care is expensive because we have collectively made it that way, and the only way to make it less expensive is to stop demanding more of it -- this is why "less equals more" when it comes to health care. The attitude that our insurance card is a black Centurion American Express card with no spending limit MUST change. The question is, are people willing, or will they wait till there is another tax increase to pay for these unnecessary tests?
Dr. Veronica Anderson is an ophthalmologist-eye physician and surgeon trained in NYC at Mount Sinai Medical Center. She currently coaches and consults other entrepreneurs on branding and marketing, and has a training program for doctors being launched in the fall. If you are a doctor looking for help in bettering your practice, or this article brought up your concerns about unhappy patients or malpractice claims, Dr. Veronica can help at www.richdoctorcoaching.com
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