On Nov. 1, the federal government issued a final decision that will result in Medicare cuts of 4.5%. In an already dysfunctional and overcrowded healthcare system – this is going to be a problem for you (the consumer) – and here’s why.
Health care is ultimately a business. And its purpose is to make a profit. Revenues and profits come from things like procedures, tests, images, and surgery, not from preventing disease and keeping people healthy.
What does this mean to you?
This means that health care specialties such as orthopedic surgery, neurology and gastroenterology, for example – those that are procedurally focused – generate higher incomes and are paid more for their services. On the other hand – disciplines like primary care physicians, rehabilitation therapies (like physiotherapy), and endocrinologists (those who manage chronic conditions like diabetes and osteoporosis) – are paid less. The consequence is that the disciplines that really need more time with you – so they can get to know you and your lifestyle – because that’s what is needed to give you a good strategy for disease and injury prevention – are forced to do more work for less .
Eventually, something has to give.
Family doctors have to see patients every 10 minutes and that’s only if you can see them in a timely manner. Physiotherapists have to see several patients per hour, which translates to 12 to 16 patients per day. These workloads and demands make it difficult for a healthcare professional to really get to know you as a person, what your concerns are, or what your particular lifestyle and burdens are. (A recent comment by Shirlene Obuobi, MD in The Washington Post illustrates this dilemma quite well.) These are all critically important factors if you want to get effective treatment and advice that matches your needs and produces the result you want. you wish. The consequence is poor preventive care. And you risk being unnecessarily referred to the “specialist” who uses fancy tests and procedures (instead of getting to know you and asking questions) to make (often costly) decisions about your health.
Now, my intention here is not to portray specialists who use procedures and tests as their standard of examination as the “bad guys”. The problem is that you, the patient, are being pledged too soon because the people who are supposed to protect you and help defend you against illness and injury are being crushed (and not valued) by health insurance companies. . Medicare tends to be the leader and everyone is following suit. If those 2023 cuts materialize, commercial insurers will be next.
So what can you do?
First, you should do everything in your power to educate yourself about health and wellness so you can prevent illness and injury yourself. This may require hiring some key preventative healthcare professionals to guide you – like getting your own dietitian, physiotherapist, and mental health professional. Ironically, we already do this without even thinking about it when it comes to our dental care. Why wouldn’t we want to do that with other aspects – like digestive, mental and musculoskeletal health? Health insurance companies are adding red tape when it comes to accessing these services – like requiring a referral – that our already overburdened primary care physicians don’t have time to provide.
This brings me to my second recommendation…start thinking outside the box and be willing and able to invest in the health care you want and need. Believe it or not, getting out of your health insurance and paying out of pocket for preventative healthcare services isn’t as expensive as you might think and your options are opening up exponentially. Especially if you budget and plan for it. At some point, it will no longer be in your favor to rely on your health insurance to fund all of your health care needs – because clearly they are not interested. Instead, take a look at your finances and start budgeting. One of the best ways to do this is to open a health savings account. If your health plan doesn’t allow it, open a separate savings account to save on your own. More and more practitioners are abandoning insurance – or even quitting their respective professions altogether. If you want to stay out of the hospital or big company healthcare systems and see someone private who has the time to look after you, you’ll have to be prepared to pay. Personally, I believe this is the way to go, but I understand it’s not for everyone. However, with a little planning and foresight, it could be. Although I hope things will eventually change in the long term – I believe that staying educated, gaining some control over the administration and funding of your health care in the short term, is a much better alternative than going in Washington and fight Congress on your own.
Dr Carrie Jose, physiotherapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch or get one of his free guides to preventing back pain, knee pain or vertigo – visit www.cjphysicaltherapy.com or call 603-605-0402.
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