The Healthcare Professional and The Expert
A perception that has stuck around despite the rapidly changing world around us is that “if my doctor said it, then that’s what I should do”. Doctors are listed among the most trusted professionals in America (3rd to nurses and pharmacists). Everyone knows that medical professionals take this oath where they promise to help and not to hurt. Society trusts them to do just that in all their interactions. So why not do everything they say because their intention is to help me? They studied medicine for 17 years to become a doctor so they REALLY know their stuff, right?
And it’s true. Medical professionals of all kinds study their brains out to earn the status of “expert” in their field. Then they continue to study and learn for the rest of their lives to keep up with the changes in their industry. Another thing the oath they take says is that “medicine is an art as well as a science”. Science tells us what appears to be best for “most”, the art comes in when we figure out what’s best for YOU.
Art? Science? Healthcare Business!
Thanks to this industry we’ve built called “health insurance”, the idea of helping but not hurting is no longer an art or a science. It’s a business venture. Before the Affordable Healthcare Act (ACA, ObamaCare), insurances could look at people applying for coverage as “investments”. That is why women of childbearing age had more expensive premiums for the same type of coverage as their husbands. They evaluated the risk of that woman having a baby, and the insurance has to pay for it was an expensive risk. I remember when Ken and I first got married and he looked at putting me on his insurance. His premium for himself was $170/month, to add me increased the premium to $650/month. It is also why people with pre-existing conditions were denied coverage because the risk to cover them was too expensive. The removal of this level of discrimination and dehumanization of healthcare has been one of the positive aspects of the ACA. But it’s not completely gone…
Healthcare companies may not be able to deny coverage of the person due to age, gender, or illness, but they still approach healthcare as a business and not as science. As new drugs are developed and studies are published to show which ones are superior to the previous treatment standards, insurance companies are SLOOOOOW at adapting. They know the new medications are more expensive and have a lower Return on Investment (ROI). Thus for a long time, insurances preferred to pay for Warfarin (Coumadin, a blood thinner that required blood testing as frequently as once a week) over the new blood thinners that didn’t require testing and dosing adjustments.
Turning the Healthcare Titanic
It has also taken Insurance far too long to understand the cost-saving benefits of Preventative Care. If they pay for your vaccine, then they won’t have to pay the doctor or the hospital to treat you for a preventable disease and all the complications that go with it. The trade-off of paying for annual or bi-annual check-ups versus waiting until you have a heart attack to find out you had high cholesterol. Now there’s a multitude of problems to treat (and pay for). They’re finally getting a clue that they should pay for almost every contraception option (excluding OTCs) because birth control (even IUDs and implants) are cheaper than paying for a baby.
Trying to get the Compliance train rolling with insurances has been ridiculously hard. Compliance in Medicine means that you take 80% of your medicine when you’re supposed to and the way it’s intended. Many state Medicaid programs don’t allow members to use a program most pharmacies have that automatically refills prescriptions (Auto-Fill, Auto-Refills). They actually think they’ll save money by waiting for the person to get severely ill or have a health emergency, rather than ensuring the person consistently takes the medication that is getting or keeping them well.
A Glimmer of Hope
Medicare, as well as a handful of other insurances, finally got a clue. They realized that allowing people to get three months of their medication at a time saves money. Also, you’ve removed eight chances for someone to forget refills because they only visit the pharmacy four times a year. This is the definition of improved compliance.
Be a Chameleon
Medical professionals still desire and strive to practice the art and the science of medicine. But most of our day, we find ourselves playing the part of a chameleon. We want insurances to understand that if they treat you as human, they actually save money. The biggest gap to close is the one where we want to help you stay well, rather than just take care of you when you’re sick.
