Potential Consequences for Postponing Healthcare

AMERICANS ARE POSTPONING HEALTH CARE: The potential consequences and what you can do to help your family.

by Nolan Hetz, M.D., F.A.C.O.G.

April 22, 2009

 

The downward spiral of our struggling economy and the resulting widespread fear and uncertainty of our individual financial health have forced unprecedented health care decisions which could be detrimental to your health now and in the near future. This was confirmed in a Washington Reuters poll of 12,000 people conducted in February and March of this year. The survey noted that 20% of Americans have delayed, cancelled, or postponed medical care, mostly doctor's visits. 25% of those surveyed said “cost” was the main reason. Another survey in December 2008 by the National Women’s Health Resource Center found 22% of women have chosen, due to healthcare cost combined with economic factors, to either put off taking their children to the doctor or decided not to fill prescriptions.

 

There is no doubt many more women in the past eight months are not scheduling preventive annual examinations. In addition, there has been a noticeable and drastic rise in missed doctor's appointments, in the cancellations of screening mammograms and osteoporosis tests, and in patient’s unwillingness to schedule recommended diagnostic ultrasounds or X-rays, including CT scans and MRI scans used to detect disease deep inside the body.

 

In the past six months, I have seen fewer patients per week but noticed a significant trend, in those who are being seen, showing up with more severe problems due to their delay in calling for an appointment to be evaluated for newly acquired symptoms like pelvic pain, abnormal menstrual bleeding, and even urinary tract infections. Case in point, one middle-aged woman with abnormal menstrual bleeding early last September refused to have a simple sampling of the uterus. Six months later, she was forced to have this much needed evaluation and ended up having a hysterectomy for cancer which required postoperative radiation therapy and chemotherapy. Only time will tell whether her past decision to delay her health care intervention will negatively affect the quality of her life or her longevity.

 

How can women still get their preventive healthcare exams and address new health issues in a timely fashion without placing undue burdens on the family's financial foundation? Here are some suggestions:

 

1. Do health care “cost shopping” by calling around, even if a potential healthcare provider is not in your health insurance network. For example, some gynecologists can safely and appropriately evaluate and treat heavy and painful menstrual periods in his/her office, saving $3000 to $5000 compared to the same procedure performed in a hospital setting. In addition, a tubal ligation for sterilization or a urine loss sling procedure can be performed nowadays in an office setting more cost-effectively and without sacrificing patient safety or treatment effectiveness.

 

2. Ask your health care provider for assistance on your bill. This must be a request from you, the patient, and it can only legally occur after you receive the doctor's or hospital's bill that lists the pre-set standard fees for the services provided. I can assure you that many healthcare providers are willing to provide a 15-25% reduction in your bill and if you have been making regular payments in the past and if you simply ask for such assistance.

 

3. Use your Health Savings Account monies wisely and make sure you understand your insurance's jargon for "co-pays" and "deductible" amounts for in network healthcare providers and out-of-network healthcare providers. There are many situations where a patient's out of pocket expenses are much less when care is provided by an out-of-network provider who performs office-based treatments and/or procedures as opposed to many in-network providers who are only able to provide similar treatments and procedures in a hospital operating room where hospital facilities fees alone can be close to $8000 to $10,000. In other words, a 10% to 30% co-pay for an in-network hospital and physician may cost you more out-of-the-pocket dollars than an out of network physician who performs these same procedures more cost effectively in a well-equipped office.

 

4. Remember that your insurance company usually is working for their stockholders and their use of "co-pays" and "deductibles" are their legal way to encourage you to not to seek care unnecessarily. Some say it's an indirect way to ration available health care services or to transfer more of the health care expenses on to the health consumer’s shoulders. The insurance industry's ongoing use of partnering with certain hospital systems and providers exclusively has failed to control rising health care costs and the over-utilization of health care services by healthcare providers and healthcare consumers. However, if your chest pain is originating from a clogged artery to your heart or your abdominal/pelvic pains are originating from a cancerous condition, your delay in using your Health Savings Account monies or your decision to delay an evaluation because you have a high deductible may only save you money in the short term. Many research studies have confirmed, in many cases where health care is postponed or delayed, it will cost a person more money in the long term, including possibly costing him/her a higher quality of life or shorten his/her longevity.

 

5. Ask your health care provider for higher dose pills and cut the pill in half or in a-third to achieve the desired therapeutic dose. Most medications, including those in a capsule, can be divided by opening the capsule of a higher dose medication and then dividing the contents with a razor or a fine knife. Placing the desired dose in a food or drink is sometimes allowable. However, only do this to your medications if okayed by your doctor or pharmacist. Some medications are timed-released pills, which when split, can negatively affect their effectiveness and their safety. Some medications in capsules need to bypass the stomach and be released in the intestines, while others can burn or damage your esophagus, thus making the act of splitting the higher dose capsule ineffective or unsafe.

 

6. Seriously consider getting a second opinion before having any non-emergent or elective minor/major surgery. For example, 30-60% of hysterectomies are possibly unnecessary or are ineffective in treating conditions such as chronic pelvic pain or painful relations. Likewise, many bladder control problems do not require hospital-based surgery while the use of many $100 plus prescription medications to treat overactive bladder problems are less effective and have more side effects than the other more modern treatments like electrical stimulation, biofeedback, or the incontinence chair treatments. Most people are not aware that a hysterectomy can cost an insurance company over $25,000 or a urine loss sling procedure at a hospital over $10,000 to $15,000. In essence, spending $100 to $175 for a second opinion may save a person thousands of dollars in surgical costs, in co-pays, and in lost wages.

 

7. Ask us doctors and hospitals more questions, including asking for estimates of what a recommended evaluation and treatment option will entail and cost. Also look closely at your bills as up to 10% of office/physician bills and 30% of hospital bills have errors, most toward a higher amount. Don’t rely on your insurance company to identify or tell you there has been a billing error as frequently their statement that a charge is “above usual and customary fee” may be their attempt to transfer an unpaid amount from the hospital or from your physician onto your shoulders. Contact your doctor’s and/or hospital’s billing department for assistance after you have contacted your insurance company for their company’s “cost savings” position.

 

My concern over the next couple of years is that the learning curve for healthcare consumers may be slow and hampered by unwise knee-jerk decisions to delay health care related investigations and/or treatments. In the future, once healthcare consumers have more of a financial stake in deciding which diagnostic and/or treatment options to pursue, they will naturally seek and choose more appropriate and cost-effective health care.

 

In some respects, these new economic stressors which are affecting healthcare decisions may be good in the long term as they will hopefully help change the mindset of both us healthcare providers and the average healthcare consumer. We all have a responsibility to seek more cost-effective evaluations and treatments without compromising the quality of care we physicians provide or that which the healthcare consumer individually seeks out.

 

Dr Nolan Hetz is a board certified gynecologist and is a female bladder control specialist in Manitowoc. If you wish to ask him a health related question, request a women’s health presentation for your group, or desire a copy of one of his previous “Ask the Doctor” articles, you may call his office at 920-683-0321 or email him at nolanhetz@yahoo.com.