One of the comments on the last post was in regards to my thoughts on current healthcare, specifically, "modern medical organizations and health care. I would also love to know your thoughts on poverty as it relates to long term health care and urgent/emergency care".
Let's tackle it!
Anytime there is a transition, there are growing pains. I'm not an expert on any of this, but I can offer my insights and would love to hear your thoughts, too. With the implementation of Obamacare or the Affordable Healthcare Act (ACA), we have seen a lot of changes. Personally, I have seen my premiums increase, coverage decrease, co-pays increase, and time with doctors decrease. While we are "young and healthy", we're concerned with what our healthcare options look like in the future. Professionally I see (some) patients weekly, there are no co-pays, medications are free or very low cost, they demand specialist care or additional unnecessary services (x-rays, ultrasounds). I am spending my own tax dollars on my patients! The downside to some of these services is the wait. For example, a patient with a positive fecal blood test can wait up to 2 years for a colonoscopy. A friend with PPO insurance recently waited 6 weeks....so, the wait is substantial.
Personally, deciding to go to the Dr is a big deal. How sick are we? How long have we been sick? Do we really need to go? Do I want to pay the $30 co-pay? Thankfully, I'm a nurse (!), so I can triage us at home and have us wait it out as long as possible! Obviously, if something is imminently wrong we go to the doctor.
Having the financial commitment by paying for insurance at work, co-pays, medications, etc., definitely creates an investment in my health. Some of the patients who have no financial investment take advantage of the system. They receive over-the-counter medications for free, do not have co-pays for their visits with me or other specialists, no deductibles. Unfortunately, this has created a sense of entitlement among some. We firmly believe that even a $5 co-pay for visits or labs or medications would greatly improve their buy-in to the own health. They would not come in for a visit for a runny nose for 3 hours. They would be proactive with their health at home and we would have better utilization of services. Because patients are coming in for runny noses for 3 hours, they take a spot for a patient who needs a pap smear because she had an abnormal one 6 months ago and has history of HPV. They take the spot for a patient who is having chest pain on exertion that is worsening. They show up in the ER for these things, too, impacting our hospitals.
I work in a low-income, urban clinic and see the ACA in action all day long. Most of my patients are living in poverty, some work, some don't, some are illegal, some aren't, young, old, middle aged, healthy, sick, depressed, and in pain. Many of them come from Third World countries. Our healthcare system is different than where they came from, but it's also in transition. We're confused and we live here; imagine how they feel! There is so much education that is needed, where do you begin? The patients I see come from countries that seem to be about 30 years behind us, medically. Most patients still want penicillin for everything. It's an uphill battle. Do I spend time educating about proper antibiotic use? Or proper use of the emergency room? Or the availability of acetaminophen and ibuprofen over-the-counter? Yes. I do all of that. And teach about diabetes, hypertension, and bacterial infections. In 20 minutes. It is nearly impossible to change an entire cultural belief system. I say 'nearly' because I have hope I can influence my patients who can teach their families who teach their friends. It's exhausting and mostly unrewarding, but the few patients who report back are what make the efforts worthwhile.
Check back next week for part 2 where I, hopefully, answer the initial question!
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