For my parents, healthcare was so much less complicated.
No one ever heard of in-network and out-of-network charges. You got one bill, and almost everything was covered.
By the time I became a doctor, and later a parent myself, everything was different. Healthcare decisions were much more complicated.
Two of my kids had potentially serious health concerns. And even though I’m a doctor, the experience was baffling and overwhelming. We were shuttled around to different specialists. None of them talked to each other. They all had different ideas about what might be wrong, and no one was in charge of putting all the pieces together. In-network, out-of-network – it didn’t matter, it was all incredibly confusing and expensive.
Fortunately, everything turned out OK for my kids. But I still think a lot about those experiences, because I see and feel how stressed our patients are over their healthcare bills and how confused they are by all the information overload.
Here’s what happened
Until the last few decades, if you got seriously ill, life and death were often matters of luck. We didn’t have antibiotics and vaccines in wide use. Modern heart surgery hadn’t even been invented. We didn’t know nearly as much about how the body works. We didn’t have all the technology that saves lives today. With so many more treatment options available to us today, healthcare has become much more complicated and expensive.
With medical advances came longer life — and with longer life came chronic illnesses like diabetes and heart disease plus diseases like cancer.
These complicated long-term problems brought complicated long-term treatments, almost none of them as inexpensive and simple as those early shots and pills. And with more treatments came more specialists – and less communication with each other and with patients.
Moreover, understanding the cost of treatment became such a mystery that the answers aren’t usually known to doctors or patients for months after care starts, even though insurance coverage is the first question you’re asked in nearly every medical office. As out of pocket payments have increased and each insurer has implemented different rules controlling the care that patients and providers can choose, total cost of care has become much more important than whether or not a specific provider’s in network.
No wonder healthcare’s gotten harder.
A new approach to healthcare decisions
Not every health issue needs the latest advances in treatment. On the other hand, some conditions really benefit from everything modern medicine can offer.
New approaches to patient care recognize this reality.
For example, “medical homes” coordinate care for all health issues related to patients with chronic health issues, even care provided by other doctors. At the other extreme, urgent care clinics keep minor injuries and runny noses out of the ER. Concierge medicine and integrated care provide highly personalized, comprehensive attention. And for cardiac emergencies – we have hospitals.
We see this in our own pain management practice. Simple, inexpensive home care and over-the-counter pain relievers are fine for mild sprains. An urgent care clinic can handle cuts that need stitches; you don’t need a hospital emergency room. But if you have severe chronic pain from a traumatic joint injury, you almost certainly want advanced treatment options coordinated with specialists.
What this means for you
As these new models emerge, how can you choose the right treatment approach for your next encounter with the healthcare system?
Here’s the approach we’re implementing in our practice:
First, focus on the patient’s diagnosis – what’s actually wrong, and how is it likely to affect the patient now and in the future? How complicated is this condition?
Then, help patients choose the treatment option that makes sense for their individual situations, including the cost of each option and personal treatment preferences and priorities.
Finally, act – put the plan the patient chooses into action.
This approach makes it possible for patients to choose the healthcare experience they want while getting the treatment that they need, at a price that makes sense for them.
It’s a model that works for any health decision you have to make.