Sunday, February 21, 2010

Healthcare, A Broken System

I have been reluctant to post any issues pertaining to the health care system on this little blog of mine because it seems like this is such a loaded issue these days. First I need to state that I work in the healthcare system. I work in rehabilitation and have done this work for many years so my view will be very different from say an insurance administrator or someone familiar with the healthcare system from only the point of view of being a patient in it. The healthcare system in the United States is broken. The current system does not work. What most people don't realize though is that it is not those who have nothing that are in need of decent healthcare, the most neglected citizens in our current system are those who work but are either kept just under the minimum hours to qualify for coverage or work more than one job, but not enough hours at each to qualify for benefits. If those who had absolutely nothing would stop using the emergency room for basic health services this would generate a huge savings overall.

This is of course only one side of this multi-sided issue. The side that I am going to focus on today is the one in which insurance companies are allowed to dictate and make healthcare decisions for patients. As a professional, my first instance with this was when I was on the phone trying to get approval for more therapy sessions for a child. The insurance administrator told me that she could not approve more sessions as the child had not made progress. This was after I had sent her a detailed summary showing how much progress had been made. On the phone this insurance representative actually admitted that she didn't understand the information in my report and that she would need to get more clarification. The child was able to get more services, but I wonder how often there is a positive outcome to these interactions. Not only is this demeaning for a person who put themselves in debt going to school to specialize in an area that they just might know more about than the pencil pusher on the other end of the line, but it compromises care for all patients when business representatives and not medical personal begin making life altering decisions regarding medical care.

Nothing could better illustrate this point than the healthcare debacle faced by some close friends of mine this week. The husband/father fell at a ski area and broke his leg in several places. This necessitated ambulance transport to a nearby hospital which was not at all near to where the family lives. He had to have surgery. During his five day stay in the hospital various hospital representatives, never the medical personnel, told his wife that he would be transferred to a hospital closer to their home or discharged to an in-patient rehabilitation facility. This sounded good, but guess what?? Their insurance company would not approve the transfer or in-patient rehabilitation. The insurance company told the hospital that this man should be discharged and sent home. This edict was given when he still had a catheter, could only get in and out of bed via two-person assist, was still on IV medication, and had began to develop skin breakdown because he had not been moved in the last five days. On day five he did get a shower. To top it all off he would need to go down a flight of stairs to reach a bedroom in their current home and their mattress at home is on the floor. Yes, shocking as it may seem this is the state of healthcare for insured patients in our country. Yet I still remember a number of years back when my brother was high on drugs and went to an emergency room to have a splinter removed. The bill for that visit was over $300.00 but he was homeless and unemployed so he didn't have to pay a dime. Later, when he was rehabilitated and no longer on drugs I asked him why he did things like that he told me it was because he didn't think that he should have to make an appointment and wait. Hmmm...I wonder how many people in our country think that they shouldn't have to wait for healthcare services.

So back to my story. Yesterday my friend was catheter free, but had not yet been able to get out of bed and make it to the restroom without a two-person assist. His wife was becoming hysterical regarding how she would possibly be able to work full-time, take care of their two-children, and nurse him back to health without any assistance. Finally the insurance company agreed to some in-patient rehabilitation in a nursing home. He can stay there for a week and try and learn to get around without two extra people helping him. For their sakes I hope that he can make a speedy recovery, it just sucks that the care that they have paid for offers so very little in return.

1 comment:

Kristi said...

Wow...this is truly horrible. I too worked in the hospital industry for quite a while on the financial side and I have to say that the system is most definitely broken with no apparent solution in sight. The casual ER use is for sure one of the major problems. As is the insurance companies. It seems to be getting steadily worse...

Hope your friend gets through alright and his poor wife stays sane!