Each year takes on a unique character, so will this be the year of midterm elections, the year of political revelations, the year of electric vehicles, or what? My answer is 2014 will be the Year of Health, and especially your health!
Nearly every front page and media news show includes coverage of the impact of the Affordable Care Act on insurance and the continuing problems with the newly developed exchanges. However, this issue is not the heart of the problem.
In America, we have enjoyed the best health delivery system in the world if you have had good insurance to allow you access to our miraculous medications, revolutionary surgeries, excellent hospitals and diagnostic technologies. Patients from around the world seek medical care here, if they can afford it. To help those Americans without any or without good insurance, changes implemented by the Affordable Care Act have tried to improve the system and reduce costs of care. This will be the test year to see how successful this legislation will be in practice. It will be a year of health, better or worse. And if worse, a year to improve the situation.
But beyond access issues, approached by insurance reforms, what effect will the changes have on more important elements that we have all counted on to maintain or improve our health? Let's examine the three foundations of our health: doctors, hospitals and science.
The core relationships of patients with their physicians have been impacted by the act. In my community, doctors are angry at reduced payments for their services and exclusion from insurance preferred networks, while their costs have increased and requirements for compliance are more complex. Verifying insurance coverage and getting authorizations for care have become more tedious and time-consuming. With difficulty in maintaining income, some physicians are now selling their practices to hospitals, retiring, joining large clinics or networks, or relocating to states with more favorable payments or fewer regulations. This is reducing the focus of the physician on the patient by shortening time for examinations and patient discussions, distracting the physician from patient care issues, reducing office efficiency, and giving physicians symptoms of burn-out which can increase the risk of medical errors.
In hospitals, many expensive tertiary centers have been dropped from health plans. Emergency rooms have experienced greater numbers of poorly insured patients seeking care, making it difficult for more critically ill patients to be seen swiftly. Sometimes, I find nurses spending more time documenting care than actually delivering care. With fewer nurses resulting from cost reductions, patients may wait longer for help with pain, bedpans, medication, or exiting their beds, resulting in possible errors.
However, medical science has succeeded in producing impressive tests, treatments, preventive medications, and screening technologies, all of which have improved patient outcomes. Deaths from heart disease and cancer have decreased extending the length of life of Americans. But some of these are very expensive, and may lead insurers to decline to pay for them in all patients. This will frustrate those patients whose requests for authorizations are declined.
So how can individual patients be certain that in the midst of all these changes, their care is improved rather than reduced? Here are my tips for people to make sure this Year of Health is a good one:
• Evaluate your doctor to be sure she/he has not been changed by the reforms. Are there signs of fatigue, stress, too little time for a visit, distraction, lack of answers to your questions? Having another person (family, friend) with you to help assess your doctor is good. An evaluation test for your physician is available in my book Surviving American Medicine. If your doctor seems to be slipping, it is probably time for a second opinion.
• When you have a doctor who is engaged, attentive and caring, ask his/her advice about how the hospital is doing in delivering quality care. If one hospital is not maintaining good quality, get the physician's advice on selecting another hospital. And know which urgent care facility and/or emergency room will be best for you in event of an accident or illness.
• Explore getting all the information you can about your illnesses or conditions from your doctor, publications by agencies, advocacy groups, support groups, and the internet. Make sure your physician has considered using all the tests and treatments which are being recommended in national guidelines for your condition, or is able to explain logically why they are not appropriate. If you have any questions, get a second opinion.
The good news is medicine is able to offer patients better therapy. The bad news is it may be expensive and sometimes difficult to access. You will have to work with your team (physicians, family, insurance company, hospital and pharmacist) to protect your health. Working together, 2014 will be the Year of Health. Your health.