A doctor explores how a powerful medical system is too often kept behind administrative barriers.
 | By Alex Ellerbeck Editorial Assistant |
Many of us have dealt with the challenges of navigating the American medical system. Calling the doctor's office, managing bills, checking prescriptions and waiting endlessly on hold with insurance companies — often while dealing with a serious illness — can feel like a crushing burden. Sometimes, these obstacles can keep patients from getting the care they need. |
For a long time, I've wanted to find someone who could write about all the bureaucratic hoops of American health care. It's a huge part of the experience of being sick in this country. But how do you tell an interesting story about paperwork and sitting on hold? |
Dr. Chavi Karkowsky, who specializes in high-risk maternal-fetal medicine, has spent a lot of time thinking about this administrative burden, one that is, as she writes, "almost always boring" but also sometimes the source of "tremendous and unnecessary human suffering." In a guest essay published today, she discusses these challenges and how they can be addressed in our medical system. |
America's health care system is massive and powerful. It can spring into action to perform lifesaving feats. In her essay, Karkowsky writes about a pregnant patient who shows up at her hospital with an acute kidney infection, at risk of preterm labor and septic shock. "Within minutes, a team was swarming the triage bay — providing oxygen, applying the fetal heart rate and contraction monitor, placing IVs," she says. |
But the reason the patient had become so ill in the first place is probably that she couldn't get medication she was prescribed several days earlier; there was some issue with her insurance coverage. A delay in getting a cheap antibiotic resulted in a prolonged hospitalization. |
Some of the bureaucratic hurdles patients encounter are at least arguably there for good reasons. The problem is that we aren't factoring in the burden on patients. "There's nobody measuring the time spent on the phone plus lost wages plus complications from delayed care for every single patient in the United States," Karkowsky writes. One of the few data points we have is a recent study that found that around a quarter of insured adults report that their health care has been delayed or missed because of administrative tasks. |
A lot of Karkowsky's time as a doctor is spent trying to help patients navigate these administrative obstacles or their consequences. She writes, for instance, of one patient who very likely lost most of a day's wages ferrying documents between a Medicaid office and her pharmacy to prove that her diabetic supplies should be covered. |
Karkowsky suggests that there are possible solutions, such as simplifying paperwork and providing and paying for work in the medical system to help guide patients through the administrative maze. One of the first steps, however, of any solution is working toward a better accounting of the costs of administrative burdens. Doing so will come with challenges. "It's not a metric the health care industry is used to evaluating," she writes. "But it's not harder than doing the work itself, as patients do." |
Here's what we're focusing on today: |
Forward this newsletter to friends to share ideas and perspectives that will help inform their lives. They can sign up here. Do you have feedback? Email us at opiniontoday@nytimes.com. |
|
No comments:
Post a Comment