How I Would Fix Healthcare – Step 4

This is a continuing series addressing the healthcare crisis in America and a possible alternative to President Obama’s healthcare solution.

Step 4: Preventative Healthcare Maintenance Schedule

With all of this talk of America’s failing healthcare system, we have put all of the blame on price-gouging insurance companies and greedy pharmaceutical manufacturers. However, some of the blame for high healthcare costs rests on the shoulders of ignorant or irresponsible patients who don’t go to the doctor for annual checkups or patients who do not take their medicine, nor follow doctor’s recommendations for diet and exercise. A poorly disorganized and overworked general practitioner’s office can exacerbate the problem by failing to call or write with reminders that it’s time to schedule that yearly checkup. I get more notices from the vet to bring in my cat in for annual shots than I do from my own doctors.

Most of us start out quite healthy as young adults. For that reason, we tend to shirk off our yearly physicals and don’t worry about our lack of health insurance. Then, one day, twenty years later, we may go to the emergency room with chest pains and hear, “Surprise! You have had a heart attack.”

Perhaps you don’t go to the eye doctor because you can see “perfectly well,” until one day when you find you can’t see to drive at night, and go to the eye doctor to discover that you have advanced glaucoma.

Sore on the leg that won’t heal? “It’s too late. We’re going to have to amputate. Oh, you didn’t know you had diabetes? You feel fine, do you?”

I blame insured American’s disinterest in going to their doctors for annual checkups on three fundamental problems: a lack of health education, forgetfulness, and difficulty in getting appointments that fit into busy work or school schedules.

Both my husband and I consider ourselves to be quite sharp and well educated, each with college degrees. However, neither of us knew that we should both get our first colonoscopy by age 50. Unlike my new car, I was not born with a book on scheduled maintenance. Instead, my parents, “back in the day,” only took me to the doctor for either A: broken bones or B: required school physicals. I had the mumps, pox, flu, strep, and who knows all what else, without ever once seeing a doctor, despite excellent health insurance. That’s just the way it was done.

“Back in the day,” the idea of going to the doctor for a yearly physical was a sign of being a hypochondriac. Even when I began to go to a primary care physician in my late 20’s, he never gave me a blood test to check my cholesterol, thyroid or blood sugar. It wasn’t until I got a new health plan in my late 30s that my doctor recommended that I take a blood test every year, at which point it was discovered that my blood sugar was a wee bit too high. If I had known that I was supposed to get these tests yearly, I would have demanded them.

Despite my newly found knowledge that I should schedule an appointment once a year, it’s easy to skip a yearly physical exam when I have other things to do, especially when I feel completely fine. Unless my doctor reminds me, I’m not likely to call.

We may be a country without healthcare, but we are also a country of patients and primary care physicians who simply aren’t doing their part. Why should health insurance pick up the tab for a major illness, such as progressive breast cancer, when the patient didn’t do their part and have regular mammogram screenings at the appropriate ages, despite having health insurance which covered it?

Little problems turn into big expensive problems over time. Untreated diabetes and high blood pressure, two very common and easy to detect disorders, both lead to organ failure. It’s much cheaper to take your insulin than it is to have a leg removed and buy custom-fitting prosthetics.

I think it’s time the patient took responsibility.

But, what is it we should be doing?

Most of us have no idea what schedule we should follow when it comes to healthcare maintenance. I get more advice on healthcare from TV’s Dr. Nancy Snyderman and Dr. Oz, than I do from my own doctor.

Many professional healthcare websites use the words, “get regular checkups.” But what is “regular?” Once a month? Once every six months? Once a year? Once every two years? The word, “regular” is far too vague.

The US Department of Health and Human Services has published its own list of recommended tests at each age online at www.hhs.gov

However, some doctors and research centers feel that this list is inadequate.

The Memorial Sloan-Kettering Cancer Center has published a schedule including additional recommended cancer screenings at www.mskcc.org.

Lab Tests Online has published a list of recommended blood tests and screenings online at www.labtestsonline.org.

The Vision Learning Center lists recommendations for when to get eye exams on their website, www.preventblindness.org.

It is clear that Americans need a consolidated list of what doctors they should see, when they should see them, and whether or not their insurance covers these visits.

Step 4: Preventative Healthcare Maintenance Schedule

A Federal government appointed advisory panel of health and medical experts shall determine what annual physicals, tests, and screenings everyone should have, at what age and at what risk level. The advisory panel shall create charts and checklists for patients and doctors to follow which are readily available online and handed out in printed form at health clinics, hospitals and doctor’s offices.

By Federal mandate, once a year, health insurance companies must send each of their covered patients an age-appropriate generic checklist with notes indicating whether or not these services are covered, and to what degree the patient will pay out of pocket (if at all).

Once the patient goes for a checkup, a customized schedule should be issued from the doctor’s office itself which is updated to reflect any changes in the patients health. For instance, if a patient has a family history or a diagnosis of a specific disorder, they will be “at risk” and need to undergo additional or earlier tests and screenings related to that disorder. Likewise, doctors should also be required to clearly inform their patients in writing when they are expected to return for follow-up visits. This should apply not only to primary care physicians, but also to eye doctors, dentists, and every other doctor the patient is seeing.

At the very minimum, patients should be given this information in a standardized printed form by each of their doctors, in a manner which is easy to read and understand. Patients could then check off completed exams, much as they would check off and date oil changes in a car maintenance book.

Ideally, this information will be consolidated so that all appointments appear on the same chart. This might serve an additional benefit by helping doctors diagnose previously undetected problems. For instance, a primary care physician might note that one of their patients with arthritis has also had cavities filled at the dentist and eye drops prescribed by the eye doctor, an indication of Sjogren’s syndrome.

Here is an example of a possible health maintenance schedule which has been custom tailored by an HMO for a young woman who is sexually active and nearsighted:

Patient reminders

Recently, my husband’s employer switched healthcare plans to Blue Cross Blue Shield. I was pleasantly surprised to receive a letter reminding me to come in for my mammogram. What a novel idea! Send a letter – so simple and so inexpensive, yet so effective.

Doctor’s offices should be required to send out reminders to their patients that it’s time to schedule their annual checkup and screenings. With all of our modern technology, it seems such a simple task for a doctor’s office computer to generate an email, snail mail, or automated telephone message, at the very least. If the patient does not respond, the doctor’s office should be required to try again, using a different method of communication.

Annual checkups should then be scheduled on an easy to remember date, such as every year within the same month as your birthday, but with flexibility to fit into patient’s busy schedules.

Healthcare insurance plans who assign doctors to patients, such as HMOs, should make sure that their doctors are adequately staffed to handle the workload of all of their assigned patients responsibly showing up once a year for their appointments.

How I Would Fix Healthcare

Step 1 – Employers must provide a minimum $300 health insurance policy allowance for each and every worker.

Step 2 – Insurance agencies may not take more than $40 per policy for profit and administrative costs.

Step 3 – Protect Health Insurance Surplus Coffers

Step 4 – Preventative Healthcare Maintenance Schedule

Step 5 – Improve Healthcare Access

A. Institute a “public option”;
B. Regulate rates with blind menu pricing; and/or
C. Provide free clinics and access to community health centers

Stay tuned for steps 6 and 7