Hippocrates' Modern Colleagues
|Patient-Induced Healthcare Costs||
by Del Meyer
Mrs Sanchez, in her 60s with asthma and chronic bronchitis, began having increased coughing, wheezing and sputum production on Tuesday. She did not call the office or seek an appointment at any time despite the fact that she was getting worse daily. On Saturday, she had her son take her to the hospital emergency room. After three hours of respiratory therapy, the asthma would not break and she was admitted for a four-day stay. When I was called to the emergency room, I asked her why she didnít come in on Wednesday or Friday to get treated and avoid this hospitalization; she said it wasnít convenient. She traded a $40 office visit for a $4,000 hospital call. Would any rule or law have forced her to come in on Wednesday or Friday to save taxpayer funds inasmuch as she was on Medicaid? She had an excuse for any regulation that I could dream up, even a fine or jail term was simply answered, "I had no choice. My kids were busy." I then tried the economic change-in-behavior approach. If you had to pay $5 or $10 or $25 a day in the hospital, would that have made you come into the office? She replied, "If I had to pay $10 a day, I certainly would have found a way to get to your office because I cannot afford $10 a day." It appears that economic incentives are the easiest, most humane, and possibly the only way to make patients accountable.
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Mr Brown, a 73-year-old widowed male with COPD, ASHD and DM with Neuropathy, who recently lost his wife, forgot to take his Lasix for several days. He became progressively more short of breath and came to the ER where he was treated for respiratory and congestive heart failure caused by the omission of his diuretic. He required hospitalization for several days to allow an accumulation of 15 pounds of excess fluid to be diuresed. When his daughter came in with him, she only then appreciate the cause of the recent hospitalization. She saw her fatherís depression as a significant factor in his deterioration, and stated she would monitor his medications better. Being a retired militaree with excellent, although irrational first-dollar insurance coverage, she recognized, as a responsible taxpayer, the costs her father added to the system.