Equal Treatment? Not Always For the Uninsured

While many would like to pretend that this is not the case, I think we are all aware of the fact that many times work done for free tends to be of lower quality than work that one pays for. It's hardly a shocking revelation. Incentive counts for a lot, and being paid is the incentive on most American's minds when considering the work they have made their career.

This makes for disturbing contemplation when you apply that little truism to the medical field. Manoj Jain at The Washington Post takes a look at the disturbing differences in care received by uninsured patients as opposed to those with coverage:

It's not uncommon for patients with no insurance or poor insurance to receive different treatment. A 2006 study of 25 primary care private practices in the Washington area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient's insurance status; nearly 90 percent of physicians admitted to making such adjustments. For patients with no insurance, alterations occurred 43 percent of the time; and for the privately insured, just 19 percent.

This brings to light an aspect of the health care equation that is oft overlooked. It is especially troubling when you consider that one out of every five patients seen by primary care physicians in a hospital setting are uninsured. From a physician's perspective, that is one fifth of their workload that goes completely uncompensated.

As physicians sometimes say, "No other professionals -- lawyers, plumbers, accountants -- provide uncompensated service to one-fifth of their clients."

There are many reasons possible for a lack of coverage, especially in times as tumultuous as these have been recently. From the workplace that does not offer insurance to sudden job loss or complications arising from pre-existing conditions the possible reasons run the gamut. It is not always a matter of husbanding one's resources or living within one's means:

My primary care friend told me about a patient who had left a boil untreated until it needed surgical drainage and intravenous antibiotics. When asked why didn't have insurance, the man said he had lost his job and was recently divorced. Stories like that helped my friend realize what injustices the uninsured face.

SOURCE: "Equal Treatment for the Uninsured? Don't Count on It. Lack of Compensation Can Tempt Doctors to Tailor Their Care to a Patient's Coverage" 10/14/08
photo courtesy of tacomabibelot, used under its Creative Commons license

Get Health Care Elsewhere, We'll Pay You!

Medical Tourism- traveling out of the country for health care and procedures.

In a story that frankly surprised me a bit, The Wall Street Journal examined the fact that some health insurance now covers medical tourism.

Via M.P McQueen at The Wall Street Journal:

Now, a handful of plans are beginning to cover treatment overseas for heart surgery, hip and knee replacements and other major surgical procedures.

While medical tourism isn't expected to be a solution to the country's soaring health-care costs, the practice is intended to produce savings for insurers, employers and workers. Open-heart surgery, which can cost roughly $100,000 in the U.S., can be done at an internationally accredited hospital in India for just $8,500, for instance. Proponents note that many international hospitals are staffed with American and European-trained physicians. Many facilities also are accredited by an affiliate of the Joint Commission, a nonprofit group that is the main accrediting body for U.S. hospitals.

Some of these plans actually pay a bonus to those who elect to travel for their medicine. This is an astounding and innovative approach.

While issues such as a lack of legal recourse and the lack of follow up care plans are certainly concerns, it would seem that this idea has gained a lot of traction since I last wrote about it. The issue that I find unsettling is the lack of certainty regarding the safety and sterility of tissues and blood used in transplant-oriented procedures and surgeries.

Still, this is an interesting option and one still in its early stages. I would say it bears watching.

SOURCE: "Paying Workers to Go Abroad for Health Care" 09/30/08
photo courtesy of crucially used under its Creative Commons license