Usually when we consider the non-insured, the non- or under-employed come to mind. But not always.
At 37, Trish and her husband have no insurance for delivery and only high-deductable for non-pregnancy care. She is an attorney and her husband a family practice doctor. If they were employed by a large system, say a hospital or a large legal firm, they'd have insurance, but as solo providers, they have opted for a high-deductable individual plan.
Anything else would be very expensive even for this double-employed couple. Remember that not all lawyers are millionaires and family doctors are at the low end of doctors income scales.
"She is very concerned about the cost of everything," notes the midwife she sees, explaining why she is having blood drawn at her husband's office. She will not ask for extra (but not necessarily indicated) ultrasounds and she's hoping for a less expensie vaginal delivery (first child was cesarean).
We feel uncomfortable with patients or doctors making decisions based on financial reasons, but maybe that's the only way to control medical costs.
Tuesday, June 4, 2013
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Boy howdy, I think I'd pony up for an ultrasound. And I was hoping for a vaginal delivery after a cesarean, too, but I'm glad they had me hooked up to all the monitors so Jana was born safely. I feel really bad for that group of non-insured or non- or under-employed people for medical costs. It's probably not a compliment to me that I'm having a hard time feeling as bad about this couple.
ReplyDeleteI've been very gratified by the understanding shown by various doctors we've encountered as we include financial/insurance considerations when discussing options. I always feel like I need to make sure they understand that we'll do what we need to do (the examples coming to mind involve Clyde's Hirschsprung's) but exploring the less-expensive options first would help ease some stress.
ReplyDeleteThe attending I have on fridays spends an afternoon of 'administrative time' each week looking at ways to decrease cost of care within the labor and delivery department. As we round and present our assessment/plan for the pts we rounded on he questions each test, procedure and continuation of inpatient care's necessity citing cost, in addition to the normal questions on what we would be looking for and what we would do if the finding was abnormal etc. At first his questions seemed out of place compared to what rounding was like with other attendings. But now the other days have started to feel abnormal to me. Now I find myself looking at each pts insurance carrier(if they have one at all) before I talk to them about discharge plans or recommend prn use of the hospitals 47$/tablet motrin(there's a drug store a block away). And I have certainly stopped recommending staying for an additional day of catered meals and nursery infant care just because the insurance will cover it without question.
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