The following post is from my mother, who is currently employed as an diagnostic ultrasound technician.
After being on both sides of the issue; as a patient as well as in a healthcare setting, I can see some problematic areas. As a patient, you want to be well taken care of. With the abundance of information on the internet, people have already pre-diagnosed their condition by the time they see a doctor. They know what tests should be administered and what medications should be prescribed. If a doctor does not agree with their self-diagnosis, they seek out a second opinion, costing more dollars for additional or repeat tests. As a doctor, they are fully aware of the information available to the public. In this day and age of incredulous lawsuits, these doctors feel that every test available must be ordered to cover every aspect of possibilities, including covering themselves, which again adds to the rising costs of healthcare. In the managed healthcare system, if these patients are seeking a second opinion within their network, there should be some sort of information sharing between facilities if they truly are a "network" of their managed care.
I recently had a patient with an interesting concept: If we went back to the way healthcare and insurance used to be, where people basically just purchased "catastrophic" insurance, and paid out of pocket for occasional office visits; you would eventually see a decrease in the cost of doctors' visits due to competitive pricing. Years ago, a doctor's visit was around $30-$50. Today it's not uncommon for a simple "I don't feel good" doctor's visit to be in excess of $200. If you need tests, say for strep throat, what used to be an additional $30-$40 is again, in excess of $200. Clinic visits would get more competitive and lower their prices to keep or attract patients. A lot of unnecessary tests would not be ordered either, if patients were paying out of pocket. Both patients and doctors take advantage of health insurance by ordering and administering too many unnecessary tests.
As a healthcare worker myself, my family's health insurance is over $1,300 per month, 80% of that being paid by my employer. My portion alone is more than we would pay for our occasional doctor's visits, but we keep the insurance for that "catastrophic" occurrence. In addition, being confined to providers within your "network" can have a negative effect. What do you do if you're traveling? The referral is also a scam: If you've had a chronic earache or sore throat, do you really have to spend the time and money seeing your regular doctor so they can refer you to an Ear, Nose and Throat specialist?
As for experience in the healthcare setting, I am somewhat involved in the insurance authorization process. They vary greatly as to what guidelines will qualify a patient for acceptance. They also vary greatly as to the amount they will pay for any particular procedure. For example: if test A costs $2,500, insurance company X might agree to pay $2,000. Insurance company Y might pay $1,500. And insurance company Z might only agree to pay $1,000. If our clinic accepts each of those insurance company's offers, they must write off the excess not covered. However, if Mr. Brown needs that same procedure and is paying cash, his cost is $2,500. Why is that?!?!
Another example of a distorted system is incidental findings: I am an ultrasound tech, and if I am instructed to do an ultrasound on the kidneys, but incidentally as I am scanning see something suspicious in the liver or ovaries, I am not able to fully document or image this finding. It must be relayed to the patient's primary doctor who then needs to order another test or refer the patient to a gynecologist/specialist. In the meantime, if this patient has something critically wrong, valuable time is lost in diagnosis!
Health care may not have been unflawed in the past, but it certainly has not been improved in recent years either. Family doctors are becoming obsolete because everyone specializes in something. There are certainly areas of managed care that need reform, and because managed care is so involved in almost every aspect of care, it is an essential topic to focus on when discussing problematic areas of healthcare.
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