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 didn’t come in on Wednesday or Friday to get treated and avoid this hospitalization; she said it wasn’t 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.