By Michel H.E. Hermans, MD
With a recent acute and serious vision problem, I have had to visit three ophthalmologists (all with different specialties) and a neurologist. I have undergone a series of tests, on the eyes as well as an MRI of the skull, brain and orbita, tests for the coagulatory system, atrial fibrillation and an ultrasound of the carotids.
This is not the first time that I am on the receiving end of the U.S. health care system, but having worked as a physician in the Netherlands – where the health care system, on average, is a great deal better and a lot cheaper – every time I am confronted with the U.S. system I am negatively surprised. All doctors were excellent, most of the tests were done properly and the final diagnosis was not as bad as it could have been.
This blog, though, is about the "side effects" of the health system.
Administrative Redundancy and Errors
Every single time I went somewhere for medical assessment, copies were made of my insurance card and my ID and I had to fill out stacks of paperwork on my medical past, medication, etc. This was the case for the individual doctors and the hospitals where the tests were done: the MRI, carotid ultrasound and Homer box (24 hours EKG) were all done in the same hospital. Still, the same stack of paperwork every time.
The MRI for the orbita was initially refused by my insurance company since, according to them, I had recently had one. The neurologist had to call and, again, the test was refused. I then was on the phone with the insurance company, telling them that, as the patient, I knew that I had not had a previous test and I told them that, as proof, they should not be able to find an invoice on the test. In total, I was transferred to five different departments, was on the phone for two and a half hours, and was promised approval of the test by fax within 24 hours. It took three days and another series of phone calls to get the approval number in hand.
First in Health Care Costs, Last in Patient Outcomes
In an interview with NPR1, David Cutler, a famous health economist at Harvard pointed out that 25% of the cost of U.S. health care is generated by the administrative aspects, much higher than in any other country. Data from the Common Wealth Fund2 on quality of care and outcomes indicate that the U.S. system is by far the most expensive when compared with a series of OECD countries, while coming dead last with regard to the outcomes. For example, on average, Japan spends $2,878 per person per year on health care (about $5,000 less than the U.S.) and has the highest life expectancy among developed nations.
We all (should) know this and this blog is not the place to write about remedies: it is just an observation from a patient. Most of the big players in health care, and particularly also the insurance companies, have no incentive to change the system and make it less complicated and less expensive. Add to that the complexity of the Medicare and Medicaid system and it is clear that this system is not sustainable and needs a complete overhaul.
The out of pocket cost for this vision problem: about $4000, and I do have a "good" insurance policy. Access to health care is declared a human right by the United Nations High Commissioner for Human Rights. The statement does not mention affordability of this right but at these prices, a large percentage of the U.S. population, practically speaking, has very limited access.
The standard maximum out of pocket amount in the Netherlands is €360 (about $400) while premiums are significantly lower. Visits to the GP and care of chronic diseases such as type II diabetes and COPD are fully covered in the insurance system: no out of pocket or copay.
$4000-$400 could have easily bought me a return ticket to JFK-Amsterdam...
About the Author
Michel H.E. Hermans, MD, is an expert in wound care and related topics, trained in general surgery, trauma care and burn care in the Netherlands. He has more than 25 years of senior management experience in the wound care industry. He has conducted a large number of clinical trials relating to devices and drugs aimed at wound care and related indications and diseases. Dr. Hermans speaks internationally and has authored many published works relating to wound management.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.