Do you ever get frustrated at the resistance you get when asking your doctor about testing or treatments you have come across in your research? There may be an explanation other than that he or she is just trying to make your life difficult. Doctors are, in a sense, not their own bosses anymore. No longer can they make decisions based solely on what’s best for their patients – that is if they take your health insurance.
Yes, you read that right. While most of us choose our healthcare providers based on this very criteria (whether or not they take our health insurance), the mere fact that they do may be greatly affecting the quality of care you receive. You see, there appears to be a discrepancy between what patients and physicians consider quality care and what insurance companies determine is “quality care.” There is a pretty simple explanation for this. Insurance companies base their standards primarily on keeping costs down. And this influences how physicians practice because they are often awarded incentives for meeting their standards or penalized for falling short.
While not all the quality standards set by insurance companies are at odds with the best interest of patients (health screenings often do save lives, for example), it still begs the question, “who really knows what’s best for you?” You and your doctor? Or the insurance companies? If a doctor has to “require” a well-visit, a vaccine, or a screening measure, let’s say, because an insurance company may penalize them in some way if you don’t comply, it sure seems as though our health care system has shifted from patient-centered, individualized care to fear-based, “cookie cutter” care. While many doctors are concerned and frustrated by the large influence insurance companies have over how they practice, the majority simply cooperate because they feel they have no other choice.
According to physicians, here are a few examples practices and standards that may not have the patient’s best interest in mind, or at the very least, do not give an accurate reflection of a doctor’s competency:
- Encouraging physicians to send their patients to certain hospitals or specialists (because they’re less expensive for the insurance company)
- Outdated screening recommendations – for example, physicians may get “dinged” for not having every women over 40 years of age get a mammogram when newer research has led to updated guidelines recommending regular screenings after age 45. Over-screening causes unnecessary exposure to radiation.
- Considering the adolescent years to go beyond 18 years old – due to the logistics, college students who go out of state for school may not make their yearly well-visits, giving their doctors another “ding” against them even though this has little to do with the kind of medical care they provide.
- Rewarding short office visits and not covering many diagnostic tools, medications, and treatments (either because they are considered too costly by insurance companies or because they are based on new advancements that haven’t reached mainstream medicine yet).
- Requiring excessive amount of paperwork and pre-authorization measures for tests and treatments – this just adds more time pressure and stress for doctors. It also takes away from the time spent one-on-one with the patients.
The patients who suffer the most are those with chronic and complex illnesses. Most of the time, the health insurance framework just does not cut it for these individuals. In light of all this, you may want to reconsider your view of healthcare providers who choose to practice independently of insurance company influence. These providers are often much more open to ordering testing and treatments that you research yourself, since the decision can be made without third party involvement. Often, these are the physicians who want to offer the best possible care for each individual patient even if it means taking a pay cut.
Yes, that means more out-of-pocket expenses, but the long-term benefits to your health will be well worth it. Thankfully, many employers are now offering a health savings account option, which allows you more flexibility in how you spend your healthcare dollars. And even if your doctor doesn’t take your insurance, you can often still get reimbursed for certain testing and treatments by submitting a claim yourself to your insurance company. Maybe someday the role of insurance companies will change for the better, but for now it may be time to choose a path that gives you and your doctor more freedom to pursue the very best care for you.