Sunday, August 30, 2009

"Health Care Costs - An Inside Story"

Recently, this reporter spent four days in the hospital, prior, it turns out, to surgery and a more extended stay in the approaching future. The following, through the filter of confusion, fear and inexperience, is his cataloging of the treatment he received while he was hospitalized.

During my four-day stay in the hospital, I was seen by nine doctors.

Doctor Number One: My personal doctor’s backup replacement. (My personal doctor was on vacation.)

Doctor Number Two: The E.R. “admitting” doctor.

Doctor Number Three: The doctor in charge of the E.R.

Doctor Number Four: A cardiologist. (Who saw me a number of times, and also administered a test, described below.)

Doctor Number Five: A doctor specializing in infectious diseases. (There was a concern that, along with my heart valve problem, I also had an infection in that area.)

Doctor Number Six: The backup replacement to the doctor specializing in infectious diseases. (It was the weekend, and the original doctor specializing in infectious diseases was off.)

Doctor Number Seven: The backup replacement to the backup replacement to my personal doctor. (Ditto, the “weekend issue.”)

Doctor Number Eight: A urologist. (The treatment I was undergoing was affecting my kidneys.)

Doctor Number Nine: My personal doctor. (It was now Monday, and he had returned from vacation.)

Nine doctors. All of whom, presumably, got paid for their time and expertise.

Their conclusion: My heart valve needed repairing. And I didn’t have an infection.

Included in the treatment during my stay was

A cardiogram

(I almost received two cardiograms, but I informed the second cardiogram technician I had just had a cardiogram twenty minutes earlier.)

A chest x-ray

An echocardiogram

(I would have received a treadmill stress test, but I was told that the stress test technician had gone home.)

And a test where they take pictures of your heart by lowering a camera down your throat. (This was administered by the cardiologist.)

I spent two days in Intensive Care.

I spent two subsequent days in the regular section of the hospital.

Every day, I submitted to at least two blood tests.

(One day, I had blood drawn twice in the same hour. Though the blood technician explained that an unfortunate mishap had occurred concerning the first batch, I strongly suspect the involvement of vampires.)

All that activity in four days.

Which made me wonder.

Was the level of treatment I received necessary, or excessive? Was it the result of scrupulous caution, or was it defensive, concerned less with my health than with potential litigation for negligence? I believe I have an answer to the second question. Based on the vibe I picked up from the doctors, I truly believe they were being sincerely and extraordinarily careful on my behalf.

Do I consider the level of treatment I received excessive? Three points on this question:

First, the treatment was for me, so, not surprisingly, I want it all.

Secondly, thankfully, my insurance will cover everything, so my concern here is more theoretical than bankrupting.

Thirdly, having no wisdom in the medical area whatsoever, I am in no position to determine whether the treatment I received was excessive or not.

It did seem like a lot. To the practiced eye, however, it may have been exactly what I needed.

Questions:

1. Is it possible to determine a line between “exactly what you need” health care, and more health care than is actually necessary?

2. If it is, is it then possible for reasonable, fair and compassionate people, trained in such matters, to come to some consensus on the general location of that line?

3. If the line is locatable, is it morally acceptable to try and determine where it is, or would any efforts in that direction be considered rationing?

I don’t have the answers to these questions. But I think they’re worth asking.

It seems to me that if people received something in the area of “the right amount” of health care, and no more, there would be money available for more (hopefully all) people to get at least a minimal amount health care.

It seems to me.

But I’m just a reporter.

I can only tell you my story.

Hopefully, it can help.
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Perhaps my Canadian readers can illuminate my American readers with their health care experiences.

4 comments:

Willy B. Good said...

Glad to hear you have health insurance Earl or opening that bill could have caused a minor heart attack.


ps- I can't get that da-da-da-da- damn hockey tune out of my head.

MikeThe Blogger said...

I am amazed at the lies and deception being promoted by the "health insurance industrial complex" in the US to stop any public health care reforms. As most Canadians we are thankful for the health services here. Sure there are some shortcomings but they are infrequent and minor when compared to the huge benefits we receive. As a recent personal experience mine goes like this... I was in Hawaii last year and suffered pains in my gut - two days in a hospital and received some tests, no treatment, with a stern warning to see my doctor when I returned home (the next day). I had colon cancer - (but I'm fine now 100% ok). I saw my doctor here on that Monday, checked into hospital and was operated on Monday night (part of colon removed) . Ten days of hospital stay - many doctor's visits, followup visits, then 6 months of protective chemo treatment to stop any possible spreading of the cells that may have been missed - many more doctors involved, many hospital stays due to chemo reaction (about 24 nights) during the treatments. More doctors involved during my recovery, surgeon, oncologist, gastrointestinal, personal GP, ER doctors, and attending physicians... The Canadian system came through with excellent care and perfect success. My two nights for tests in Hawaii billed my insurance for $11,000!!!. My out-of-pocket costs for a year of intensive medical care in Canada was about $90 - to cover the parking fee at the hospital and some coffee from the Tim Horton's.

A. Buck Short said...

Not only is our system expensive, it's unnecessarily demanding!

Went in for colonoscopy Friday. (Incidentally at Abu Graib when prisoners were offered a choice between torture and drinking a gallon of the Jonestown bowel cleansing bug juice and torture -- 89% chose water-boarding.)

I am fully Mirandized by the nurse, including the information: "There will be a nurse and a tech." I hear, "There will be an arson attack."

Lying in waiting room as they finish installing new equipment -- my colon is apparently one of the first this particular facility will have the oportunity to observe in HD. With that air they pump into you, I'm guessing they're doing without the "surround sound." An I-V bag with saline salution is hooked up to my hand. I have since asked our daughter, a medical professional, what the purpose of that was. Is it to dilate the blood vessels so they can be sure to get the anesthesia into you when they finally get you in the operating room? Or is it to fool you? So that, when they want to put you out, they just change the bag without your knowing, so you don't get unusually apprehensive? Only response I received, "Hydration kind of makes you feel better." Huh?

So I have to use the "facilities." Nurse hooks the I-V bottle of saline salution to one of those poles on wheels that make you appear to be walking around aimlessly looking for your dry cleaning. I enter the restroom.

There is a sign above a line that says "Pull cord for nurse." On exit, I inquire, "Why the hell should I pull the cord for the nurse? I'm the one with the one semi-immobilized with the I-V. Plus I'm paying $1,500 to be here. Let the nurse pull her own damned cord!" And yet, I've been invited back in 3 years.

impworks said...

Being one of your British readers and not Canadian I'm not sure you want my comment but I'm going to post it anyway ;-)

I had a brief hospital stay for a minor complaint a few years ago. After a day of preparation tests and seeing various doctors on my way into the operating theatre I'm in a room to be hooked up to the monitors and be put under by the anesthesiologist. Except the shinny machine that goes beep doesn't go beep for me. I have no life signs. They attach it to one of the staff and it goes beep. They put another set of cables on it from sterile bags and attach it to me again. I'm still "dead". Is it a problem? Not at all, along with a good bit of banter that helps me stay cheery about the op they simply get another machine and hook it up to me and it goes beep, beep, beep just like its supposed to.

How much did my stay in hospital, my surgery by the hospital's top surgeon (who carried out my procedure to stay qualified on it), the drugs I needed, inpatient and outpatient aftercare (where because its a teaching hospital I was happy, when asked, to be examined by four trainee nurses due to a technical mix up - not that I was complaining they were all attractive and all warmed their hands first) cost me?

Absolutely nothing - that's why over here we might grumble about it but in the end we love the NHS.