What could the Government’s health reforms have in store? Dr Karine Nohr looks at the impact of the internal market in the US
Whilst I was in the States, my cardiology host with whom I was staying, was phoned by her friend, who was having severe chest pain. He had attended the Kaiser hospital that was covered by his insurance and been diagnosed with a viral infection, and discharged with antibiotics (not a good start).
His severe pain persisted and he was worried. She told him that she would return with him to the hospital and review the investigations (her own hospital was not covered by his insurance). She met him in the carpark and found him in too much pain to walk. She went to get him a wheelchair, but found that it required a 25 cent coin to release a wheelchair. She didn’t have the right change so she went to the check-in desk. There was a long queue and when she asked for help, was advised to seek out a 25 cent coin to bring her friend in. Having resisted pulling rank up until that point, she then stated her own job and insisted that a nurse come with oxygen immediately and attend to her friend. To cut a long story short, he was indeed having an MI.
I also attended a clinic in New York City that was for the ‘underserved’. A new young teacher came for infertility advice. She was hoping to be able to afford insurance from 2011 and was seeking primarily (obligatory for her new post) vaccination advice and secondly infertility advice.
She asked that treatments and tests be deferred til her insurance kicked in, as the private costs were prohibitive. She had previously attended a clinic at age 16 with primary amenorrhoea. At that time she was already obese and had raised BP. She was put on the pill and because she had a withdrawal bleed, no further investigations had been offered. Over the subsequent 10 years, she had ‘had periods on the pill, but no spontaneous periods’. She gave a strong family history of diabetes and of young IHD. Her BMI was 33, her BP was raised and her abdominal girth was large. It seemed fairly likely that this young woman would be diagnosed with insulin resistance, but to date she had not had ANY investigations for it. I wonder if this would have happened in the case of an insured patient.
The charming young doctor, who worked this clinic, had a five-month old baby at home. She told me that when she was six weeks pregnant, she had phoned her insurance company to inform them of the pregnancy. At 38 weeks she had phoned them again to inform that all was well, at which point they told her that she was not insured for pregnancy-related costs. She challenged them and said that they had previously confirmed that she was covered. They said that this advice had been a mistake. She, her husband (an assertive PR consultant) and her father (a psychiatrist) then spent three days of high stress, plaguing the insurance company and threatening to sue them. Eventually the insurance company conceded. Her pregnancy healthcare bill came to $40,000 dollars. One wonders how less assertive or educated people might have managed this situation.
The disparity in healthcare provision for the insured and uninsured was startling. The role that this multibillion industry must have to play, in keeping its interests protected, within a privatised health care system can only be imagined. Mention the word ‘socialised’ in terms of health care provision to some people in the States (including many uninsured), and it could be interpreted as raving red commie conspiracy, with declarations of ‘loss of choice’, ‘state interferement in people’s private lives’, ‘left-wing press propaganda’ and allegations about the NHS refusing to treat cancer patients or the elderly. It was quite extraordinary. And as a visitor, there were times when my refutations just seemed to fall on deaf ears, and politeness dictated that I just bite my tongue.
As commissioning approaches in our own country, one wonders about the implications and complications of the internal market and how fondly some of us may look back to our glorious NHS.
Dr Karine Nohr is a GP in Sheffield
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