It is no secret the US health care model is unsustainable. Costs continue to skyrocket, emergency rooms have become the primary care source for many of the uninsured, and physicians spend 22% of their time on nonclinical paperwork.
Amidst the numerous problems and proposed causes, the unpredictable and high cost of health care is an undeniable symptom of a sick health care system. The price of procedures, visits, medications, and hospital stays has become a formidable obstacle to providing care. The insured and uninsured often simply avoid medical care to escape high costs. In turn, preventable care becomes impossible, leaving emergency rooms to grapple with progressed disorders and their subsequent symptoms that could have been prevented if health care was more affordable.
One high profile recent case is a poignant example. In 2007, a 12-year-old died from a tooth abscess after it traveled to his brain. The family ran into roadblocks in trying to get him dental care during the months before he presented to the emergency room. By then, the infection had traveled to his brain, which led to two expensive brain surgeries and six weeks of hospital care before he died.
The cost of care is a formidable obstacle when caring for patients with chronic illnesses. Financial constraints can cause patients to leave prescriptions unfilled, skip important follow-up visits or resist procedures needed for survival. This can become especially problematic if a patient is on a medication requiring monitoring but resists a follow-up visit. Does the doctor discontinue the medication, or refill it with the risk of dangerous side effects?
In addition to providing care issues, physicians have to understand the financial side of the practice of medicine in order to be appropriately reimbursed. Atul Gawande does a brilliant job of investigating this in his book “Better: A Surgeon’s Notes on Performance” in which he interviews a financial disaster specialist who describes how physician income largely depends on the business side of their practice.
Doctor groups must deal with insurance requirements and making sure patients pay up front or risk not being paid at all.
The Affordable Care Act (ACA) claims to alleviate many of these difficulties with some possibly detrimental effects to doctors. However, according to The New York Times, the ACA will not control high costs from business deals that unpredictably appear on patient bills. The article illustrates how medical supplies can rise in cost due to these business deals by focusing on a simple necessity in hospitals: saline. During the 2012 outbreak of food poisoning in upstate New York, the price of saline skyrocketed from $1.07 a liter to an adult patient being billed $787 for “IV therapy” during an emergency room stay.
These problems have led to a concerning amount of physician dissatisfaction. I experienced this discouragement from doctors I knew early on in my path to medical school. Although concerned, I continued on my path to becoming a physician. While I cannot individually change the medical system, I would argue that as a future health provider we have a moral obligation to include cost as an important element in providing care and advocating for our patients’ health.
We can pursue education on the subject by way of resources such as the interactive modules offered by the American College of Physicians. Other helpful suggestions can be found in an article on ACP Internist, which suggests that residents consider the values of diagnostic tests carefully, evaluate cost as well as effectiveness concerning medications, find mentors who make efforts to practice cost efficiency, and to fully consider tests and procedures to ensure they are not over or under utilized.
Although residents seeking to provide cost-effective care might not be supported initially at their individual institutions, many residency training programs are working toward including this subject matter into their curriculum on the subject. As students, I believe we can cultivate this interest within our institution by seeking assistance either from within our institution or outside of it.