:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Wednesday, March 09, 2005  

Charity or Fair Prices?

A number of folks have mistaken this enterprise as charity care. I'd like to set the record spinning in the right direction. By labeling this as charity care, folks are able to rationalize their own financial situations as the necessary cost of education and business.

A Fair Priced Medical Practice isnt' charity, it's business. It's just not a predator model of business. There is an acceptance in our society that it is okay to prey upon other's vulnerabilities, injuries and fears. I can accept this in the selection of a car (seatbelts, airbags, SUV vs Pinto) although it still seems kinda rude. But imagine healthcare, people are at their worst moments of combined fear, illness and vulnerability. Now throw them a $1000-$100,000 bill and watch what happens...

It doesn't have to be this way, and it's not about doctors having to be poor. I have shared some of the math of this business endeavor in previous posts. And let me clarify again - this is for primary and urgent healthcare, not surgery, emergency or major organ failure / cancer medicine. Those efforts require a different economic and technical investment to achieve success. so back to primary/urgent care.

Let me share a vignette - miscarriage. For those new to the health scene, a miscarriage is when a woman loses her baby while it is still in the womb. For first trimester miscarriages there is no form of prevention, it happens in 10% of known pregnancies.

How much should it cost to diagnose, counsel and treat a woman having an early miscarriage? Take a PRICE IS RIGHT guess. $50... $1000... $2000...

Here's what's involved - you take a few moments and listen to the woman's symptoms. Vaginal bleeding, lower abdomenal cramping, perhaps passing some tissue. Then you do a speculum exam followed by a bimanual exam to feel with your finger if the cervical OS is open or closed. If you have access to an ultrasound machine you can use it so see if the fetus is alive and to make sure the pregnancy is in the uterus and not one of the tubes (ectopic), which could be life threatening. It would probably take about 30 minutes from start to finish.

Miscarriage is actually a fairly common and simple medical problem. The real problem is how the insurance and hospital systems perform. Women having a miscarriage often feel anxious, fearful, concerned that they caused it somehow and usually rush to their doctor to try to save the baby. All reasonable reactions. Uninsured women in my city have very few options and most wind up in the ER where they wait for 4-12 hours. Believe it or not, but miscarriage isn't a medical emergency. There isn't anything we can do to prevent it and unless the woman is unstable or in severe pain, she'll wait while the gun shot wounds and car accidents take priority.

Then she'll receive a bill for upwards of $1-2K for "services" rendered and sent home to see if the fetus passes on it's own. Occassionally a surgical procedure, D&C, is indicated which then ups the bill by a few thousand more.

A simple, yet scary problem with a complex and expensive solution for uninsured women. If primary healthcare functioned well in my city, this could be taken care of in an office setting for $35-100 with compassionate phone followup, something ER's have trouble doing for good reasons, it isn't their mission nor their job.

I appreciate debate and the flow of sharing experienced. Keep it coming.

posted by andru | 3/09/2005 06:26:00 AM | |


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