What people really want from healthcare

The space between the care that providers want to give and the care that the patient receives is enormous. The area is full of barriers — tasks, paperwork, and bureaucracy. Each is a point where someone can say no. There are endless appointments with different doctors, tests that need to be scheduled, and a wait for treatment that could extend weeks or months.

The administrative burden of health care is almost always tedious work but sometimes causes tremendous and unnecessary human suffering. The administrative burden includes many chores we all hate: calling doctor’s offices, lining up referrals, waiting in the emergency room, sorting out bills from a recent surgery, and checking prescription refills.

The unpaid labor required to get medical care is increasing, partly because health plans have tried to find incentives to steer treatment to reduce costs. These incentives can be a crucial part of managing costs in a country that spends about twice as much on health care, as a percent of its economy, as other high-income countries.

At the same time, creating administrative burdens is a time-honored tactic for insurance companies. “When you’re trying to incentivize things, and you don’t want to push up the dollar cost, you can push up the time cost,” said Andrew Friedson, the director of health economics at the Milken Institute. (NY Times)

Too many patients require scheduling of tests, and visiting other physicians can lead to anxiety, pain, and stress on caregivers or family members.

A very close friend of mine has a severe medical problem that could indicate he has cancer. Since his primary care physician discovered the problem, it has been over five weeks to visit an Oncologist and get the needed tests. In the meantime, he has been confined to a wheelchair while his spouse loses sleep over the possible outcome, which could be anything from hip replacement surgery to chemotherapy.

Our healthcare system is a bureaucratic nightmare for too many. Waiting weeks for needed tests have become too familiar as the staff at testing centers refuses to triage patients. Have HCPs forgotten what it’s like to have a health problem and not know what it is or treatment options?

Patients deserve to be treated with respect and empathy, but while some physicians try to convey those attributes, too many sitting at the front desk are just there to “do a job.” Insurers will complicate treatment by asking HCPs to jump through hoops to get approvals for needed tests.

Congress is currently focusing on PBM’s role in the high cost of healthcare, but they need to hear from doctors on how insurers are making healthcare more expensive and complicated. They need to explore how insurers are making record profits at the expense of patients.

The President would be well advised to ask for a bipartisian commission to address our healthcare problems. They need to listen to both patients and HCPs as they voice their frustrations and ask “what needs to happen”. What they will find out is that, in our system of healthcare, it’s too much about profits and not patients.