Transparency in health care
I had mentioned in a previous post that two of the fundamental principles of sustainable health care are intentional choice and transparency. I discussed intentional choice in a previous post. What is the importance of transparency in health care and how is transparency an important part of sustainable health care?
Transparency in health care is the ability to easily and clearly understand all of the transactions that take place with your health care. One of the most complicating aspects of receiving and providing health care is the intersection of health care coverage and the care itself. To understand what I mean, think about what it takes for you to personally access your primary care doctor. Are you part of a provider panel that your doctor accepts? Has your coverage changed as of the first of the year? Does your coverage comply with the minimal standards of the Affordable Care Act? What's your co-pay? What labs are covered? What hospitals? This is just the shortlist of challenges that each of us faces when trying to access health care. Each of these challenges that we face when trying to access health care detracts from the transparency of the interaction and ultimately detracts from the quality and affordability of your health care.
My family was recently faced with a good example of the inherent lack of transparency in health care. My mom is in her late 80's. She fell at home and was hospitalized, sent to rehab, back into the hospital and back to rehab. While she was in the hospital her Medicare supplemental insurance switched. Her insurer said that she was notified three times by mail and was required to respond but had failed to do so. Interestingly, my family had been collecting her mail and received no such notification. As of January 3rd when she was discharged from the hospital and was to go back to the rehab center for the third time, the rehab center refused to accept her 'new insurance' and told our family to come and pick up her belongings. Social services at the hospital searched for a rehab center that would accept her new insurance and could find none within 60 miles of the hospital. My mom had no recourse other than a discharge to the home of a family member.
This lack of transparency in health care requires families to advocate for their loved ones. To do so takes hours to speak with customer service representatives at the insurance company, customer service reps at www.healthcare.gov, letters back and forth. The drain on time and resources is huge. I think I'm telling a story that is all too familiar to many Americans. Ultimately in my mom's case, the insurance company could not produce a single record that would indicate that my mom was notified of a change. Her Medicare supplemental insurance is now reinstated as of 3/1/2015. To do so required the help of the state insurance commission and a threat of legal action.
Why is the system so complex with so much lack of transparency? The system is obviously unsustainable.
Jeffrey A. Oster, DPM