The ever shifting healthcare landscape has changed drastically in the past couple of decades and constant change is the only thing you can count on. The trend is that consumers of healthcare are paying more out of their pocket for healthcare services and health insurance than ever before. An unforeseen complication can have a devastating impact to most people’s financial stability. Chronic disease can also have a huge impact. Never has it been more important to be a good healthcare consumer. The challenge for most people is how to start being an advocate. That’s where we come in.
Healthcare as an industry lacks transparency, particularly when it comes to cost. When you or your loved ones are not well, cost is not often in consideration. With the shift of the financial responsibility to the consumer, you have to ask questions in order to be a good consumer. Questions help you to understand about the current situation, how the doctors will determine root causes and propose remedies. A good consumer asks the doctors and healthcare professionals around you to explain their hypothesis given the symptoms. The recommended course of diagnostic tests, lab tests and other interventions should help prove the hypothesis. Why is this important? There are hundreds of different tests that can be ordered. Understanding the appropriate test at the appropriate time is the doctor’s job. However, many doctors will practice what is known as defensive medicine. They will seek to rule out rather than prove a diagnosis, often out of fear of liability. So understanding what a test will tell you, helps you to understand the doctor’s approach and makes you an active participant in the care being provided.
There is no other product or service you would buy without asking or knowing the cost before you make a purchasing decision. Yet, healthcare has kept the true costs a mystery. Hospitals and doctors’ offices don’t publish menus with services offered at specific rates. Often these rates depend on the types of insurance you have. You’ve seen this – is the doctor or hospital an ‘in network’ provider? If not, you will shoulder the burden of additional cost.
We have been conditioned over generations that a doctor’s word is gospel. He or she knows what is best for us based on their years of education and experience. But this doctor-as-patriarch model needs to evolve with evolving pay models. The tests the defensive doctor orders may come at a cost of several hundred, if not thousands of dollars depending on the condition and the types of test. Oh and probably also depends on the type of insurance the patient has. To submit to all the tests offered is to accept the cost that is likely not known until well after the tests have been administered.
If your car stopped running, would you have it towed to a service station and tell the mechanic to fix your car without asking what the cost would be? Most people would answer ‘no’ to this question. Why? Well, because at some point, the cost to repair the car may exceed the value of the car itself. While we can’t replace our bodies or our health as easily, the cost of healthcare can be catastrophic.
Advocacy should not be thought of in just financial terms. Let me give you an example from my personal life. In the recent past, my father had elective back surgery. In the postoperative period, he was given a cocktail of drugs to keep him sedated. Unfortunately, this regimen of drugs was continued for several days rendering him unable to participate in physical therapy and initiate his recovery. He became increasingly confused when awake, however most of the time he was unarousable. I came to the city where he lives 5 days after surgery when the hospital decided to send him to long term care. As his advocate, I obtained the medication list, consulted with his doctors and nurses and dramatically altered the amount of medication being given to him. It took several weeks, but eventually his cognition came around and he is healthy and living independently today.
What if I wasn’t his son and didn’t know the things I know? He would have likely been maintained on sedatives in a semi permanent confused state in a long term facility somewhere. In the consultations with the medical staff and care team, I asked directly about the volume and dosing of medications and the possibility of interaction, especially given the fact that he had no behavioral health history or memory problems. So in this sense, it was not just a question of financial devastation, it was a question of quality of life – for the rest of his life. Oh and that would have likely been pretty costly too.
At The Institute for Quality in Senior Living, we advocate for all kinds of things related to Seniors. But one of our goals is to help you be an advocate as well, whether you are a Senior or someone helping to care for a Senior. The answer to advocacy is to ask as many questions as you can. Ask of doctors, hospitals, discharge planners, insurance case managers (if applicable) and anyone else that is contributing to the decision making affecting that Senior. Don’t be afraid to challenge the assumptions. Don’t be afraid to ask questions until you understand the situation fully. Don’t be afraid to ask questions about cost. Don’t be afraid!