The Rising Cost of Healthcare
As most people reading this have probably experienced, in one form or another, the current state of the United States healthcare system is less than optimal. The cost of insurance premiums continues to rise, as does the size of the deductible which patients are responsible for prior to healthcare covering insurance benefits. High deductible health plans (HDHPs) increased from 4 to 25% between 2006 and 2015 for employer-based plans, and close to 90% of people enrolled in Affordable Care Act plans. Out-of-pocket maximums were ranging from $1,300-$6,550 for individuals and $2,600-$13,100 for families in 2015.(1)
“The premis behind HDHPs is that requiring consumers to pay a greater portion of healthcare bills will make them more price-aware and, in turn, more likely to lower the cost of care by:
>Questioning the need for healthcare services and deciding to forgo services that do not seem necessary or valuable”
Unfortunately, this is difficult for patients to do, because of the way the medical system has been built and the way it has been run in the recent past.
The Old System
Many people are used to this scenario:
You have a musculoskeletal ache or pain, so you make an appointment to go to your family physician. You get into your family physician’s office after a few days to a week, they take a look, maybe take an x-ray, maybe prescribe you some medication, but recommend you see a specialist. You get in with the specialist after another week or two, and they recommend an MRI. A week later the MRI is done, and you go back to the specialist to discuss the results. They then recommend physical therapy, which you begin to attend after about another week.
In this scenario, you’ve spent healthcare dollars on 3 doctors’ office visits, an x-ray, medication, and an MRI. All of which took about 3-5 weeks to complete before ever even seeing a physical therapist to begin treatment.
Now imagine this scenario:
You have a musculoskeletal ache or pain, so you make an appointment to go to your physical therapist. They take a look, determine your problem is something that will likely respond well to physical therapy, and begin treating. After a few weeks things area feeling better, and all you’ve paid for are a few therapy visits.
The second scenario seems much more reasonable right? But many people believe they must go to their family physician to get a referral before going to see another healthcare provider. This “old way of thinking” can lead to increased medical costs due to unnecessary office visits, medications, and imaging as seen in the first scenario.
Continue to check back the next 3 Thursdays as I cover “The New System”, “Insurance Driven Treatment”, and “Patient Driven Treatment” in Parts 2-4.
References
(1) Landman, James H., high deductibles, high value?. Healthcare Financial Management, 2016; 70(3): 92-93.