2009-03-01
To the Editor:
A greater part of the cost of medical care has shifted from
insurance companies to the individual patient because of increases in
co-pays and deductibles. A consequence of these increases is a change
in patient behavior, which is rarely to his or her medical advantage.
Below are some examples of how these behaviors have impacted care of
hematology patients:
Follow-up physician office visits:
A
20-year-old female with sickle cell disease has started on hydroxyurea.
She should return for evaluation and blood work in several months but
now that her co-pay has risen from $10 to $50, she does not want to
come in. She proposes that she be given a prescription for hydroxyurea
for 12 months (including refills) and a yearly doctor visit. She will
go to the emergency room (ER) with any problems because there is no
co-pay if admitted from the ER. Experience has taught us that more
frequent patient monitoring can avoid unnecessary and costly
hospitalizations, but the patient doesn’t buy it.
Phone calls to physician offices have increased:
Patients, aware of their cost increase, are also aware that phone calls
are free. A patient who is in remission from Hodgkin disease presents
for evaluation of a new “lump.” Physical exam reveals something
palpable and a PET/CT is performed. The results are equivocal. The
patient calls for the results, refusing to come back to the office
because her co-pay has increased from $10 to $25. The physician is then
faced with trying to explain the subtleties of the scan and match them
up with the physical findings of the patient. With the patient unable
to see the scan and the doctor unable to see the patient, care takes
longer than average and is not paid for by anyone.
Less frequent visits to the office for blood work:
Patients now are asking that they be given a lab request slip to take
to another participating laboratory. The location may not be
convenient, but the perception is that the co-pay in the office is
higher than the co-pay at the lab. Sometimes this is true, but often
it’s not. Unlike many lab “draw stations,” our office staff is trained
specifically to maximize the viability of chemotherapy-weakened veins,
trying with great care to preserve them and avoid the need for venous
access placements. Without this diligence, there is a rise in surgical
costs, an increased risk of infections, and patient discomfort, from
both a medical and financial standpoint.
Whether or not the change in patient behavior due to increased
co-pays and deductibles is an intended consequence, the net result
could be a reduced standard of patient care. Hematologists need to help
educate both our patients and their insurance companies regarding the
danger of the new behavior.
Thomas A. Bensinger, MD
Hematology Oncology Consultants, P.A.
Greenbelt, MD
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