Health Beat: Our Access To Medical Care Is Getting Squeezed
础尘别谤颈肠补苍’蝉听health care has been rationed for decades. We听may have听gotten used to it, but it’s getting worse.
Health care is one of the most controversial topics in today鈥檚 political climate.
Will the Republicans dismantle Obamacare?听Could our next president provide universal care, and will that lead to less access to the doctors?听Will we wind up like Canada, where health care is provided for free but at the perceived price of quality or timeliness?
In the United States,听health care has been rationed for decades. We just don鈥檛 think of it as abnormal anymore.
The rationing comes in the form of not having enough doctors, limited coverage for medications, restrictions on tests, and ever-shortening hospital stays.
Start with going to see your doctor. Statistics show one in five people In Hawaii, there is a across the state and听especially on the neighbor islands.
Access is also based on insurance. Overall, statewide 听are taking new Medicare patients, for Medicaid the number is even lower at 68.3 percent.
So, if you are lucky enough to have a primary care provider, how easy is it to make a same-day appointment? Within a week? Two weeks?
According to a recent poll, 听has gone to an urgent care in the past two years after听not being able to get a timely appointment with the regular provider.
With reimbursement becoming increasingly difficult, doctors 鈥 myself included 鈥 are spending more time with paperwork and less time with patients, limiting the number of available appointments.
Hospital admissions require approval and confirmation that you are sick enough to need an inpatient stay. If approved, the duration is limited, based on the expected length of stay for your diagnosis.
I鈥檝e seen it in my own department, with colleagues telling patients when they are sick to go to urgent care so they can be seen quicker. Granted, it鈥檚 better than having people go to the emergency room and wait for hours, to be seen for less urgent conditions like coughs and colds, but that鈥檚 still limited access that we have all become used to.
Sounds like rationing to me!
What about specialty care? It鈥檚 well known that those with 听getting appointments to be seen by a specialist. Even with private insurance coverage, the copays are higher, which often limits access for those on a fixed income who can鈥檛 afford to spend $50 every time they go to be seen by their cardiologist.
When is the next available appointment? Well, in a perfect world, it鈥檚 within two weeks. Realistically, to see an endocrinologist it might take up to three months. A cardiologist, if it鈥檚 not an emergency, could take up to four weeks. A gastroenterologist, again insurance-dependent, could take several weeks to months.
That鈥檚 assuming there is one in the neighborhood. For all of East Hawaii Island, there is one neurologist. Patients are sent for specialized care, and often at a significant personal expense.
Next, consider medications. How many times have you gone to pick up your regular medication and been told it鈥檚 not on the preferred formulary for your insurance company?
It used to happen with brand name drugs only. One year, your brand inhaler is covered, next year, it’s Tier 3, requiring a much higher co-pay.
Now, it鈥檚 happening with generic medications. I can鈥檛 even count how many times a prescription for amlodipine had to be changed to felodipine, both generic blood pressure medications, because one was the 鈥減referred generic鈥 over the other one. The next year, it changes right back. Add in the numbers of different formularies for every insurance company, and it鈥檚 almost impossible to keep up.
Insurance companies don鈥檛 say you can鈥檛 have the medication your doctor prescribes, they just say they won鈥檛 pay for it. Even with an appeal, patients will often have to try generic medications and prove that they have failed before a brand name medicine is covered.
Who鈥檚 at fault if something unexpected or catastrophic happens while changing medicine? Not the insurance company.
As of Dec. 1, HMSA, the largest insurer in the state, restricted CT scans, MRI scans, stress tests and more, requiring听prior authorization from a mainland company, .听 Its听website states on the front page that its听goal is to achieve bottom line results and guarantee multi-year cost savings. , but to no avail. As of now, the system is still in place.
Care is not just rationed in outpatient settings.
Hospital admissions require approval and confirmation that you are sick enough to need an inpatient stay. If approved, the duration is limited, based on the expected length of stay for your diagnosis.
To further complicate matters, for the past decade or more, the designation of 鈥渙utpatient observation鈥 has been adopted. This allows insurance companies to pay lower daily rates for patients that are literally in the hospital, receiving the same level of care of everyone else, but due to being too 鈥渉ealthy鈥 are not granted hospital inpatient coverage for their stay.
This is especially complicated for the elderly, when skilled nursing care at a nursing home after an inpatient hospital stay is not available because the patient was admitted under 鈥渙bservation鈥 status. Confusing? Well, that鈥檚 just the beginning.
For elective surgery, there is still a process of waiting your turn. One of our busiest orthopedic surgeons where I work has a wait list of six months for his procedures. Why? Not enough operating room time available.
Health care is rationed more than most people think. We鈥檝e just gotten used to it.
But to think that we have the best health care system in the world is to be naive enough to believe that everyone has the same level of access to care, which is simply not true.
Until there is a major upheaval in the medical world, either with insurance companies, universal care or a change in the pharmaceutical industry, it鈥檚 just going to be more of the same year after year.
Soon enough,听the entire system will become unsustainable, or enough of us will be sick and tired of the status quo and strong enough to change it.
