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Why Do We Need Insurance To Cover Primary Care Costs?

As a primary care practitioner, I often am baffled by why Americans need insurance for primary, or day-to-day, care issues. When I’m talking about primary care, I mean those health problems that are considered routine, or day-to-day, problems including ear infections to poison ivy as well as many urgent care issues like sutures and draining infections. These account for a large portion of all health problems that occur in the U.S – and 80% of the things that typically up in the ER or urgent care.

My understanding is that the purpose of insurance is to protect our financial well-being and thus our financial nest egg. Investorpedia, which is part of Forbes Digital Media, offers the following definition: “Insurance allows individuals, businesses and other entities to protect themselves against significant potential losses and financial hardship at a reasonably affordable rate.”

This definition explains why we invest in insurance of all types: car insurance, home insurance and health insurance.

Then I wonder why our expectations and utilization of health insurance differs so significantly from home or car insurance. I pay a monthly premium for my car insurance, and it protects me against having to pay out large sums of money if I would be in a bad car accident. I don’t expect, however, my car insurance provider to pay for an oil change or new battery. Likewise, I pay a yearly premium for my home owner’s insurance, yet I do not expect the insurance company to foot the bill if I need a new screen door – but I certainly will turn to them if a tree crashes through my garage during a bad storm.

Then why should I expect my health insurance to pick up every small, day-to-day health issue that I have, particularly those that can cost less then $150, like a well-woman physical, help with pink eye, a tick bite or extricating a fish hook?

Don’t get me wrong; I feel that health insurance is a must to protecting anyone’s financial assets against a potentially catastrophic health event, like a tragic accident or illness. We all need to be ensured that we will not go broke if we are faced with such health issues.

I currently work for a primary care practice, DocTalker, is built to deliver affordable access to our medical team, round the clock, to ensure that our patients save cost and time. Our patients pay for a doctor’s fees when service is rendered. We base the fee structure on time and materials; our patients pay us for the amount of time they spend with the medical team. An office visit typically lasts for 15 minutes and costs $75. Believe it or not, roughly 75% of our patients pay less than $300 per year for their primary and urgent care health issues. I know of a lot of people who pay that in one office visit to the vet!

Our philosophy is that the faster we can talk to and treat our patients, the faster they will get better, thus saving them time and money from lost work, not to mention saving them in expenses from waiting to treat a condition that can worsen with time (like bronchitis). Once we’ve met with a patient face-to-face, we offer phone and email consultations, which typically cost $50.

The other thought is that if people pay, out-of-pocket, for their day-to-day care problems, then they will be more like to be aware of the cost and quality of the care they receive – much like they are with that vast majority of other purchases that they make, from a car to cell phone service to food. This will cause the consumer to demand a higher quality of care for a better price, and will lead to consumer choice and thus to consumer’s driving the market.

I don’t think that a price tag of $300 for the care of majority of primary and urgent care problems is really that much to ask; after all, many of us pay this much when we have a plumber come to the house to unplug a sink.

I think that my health is worth as much as an unplugged sink. I believe we do can it at a less expensive price. Don’t you?

Until next week, I remain yours in primary care,

Valerie Tinley, FNP-BC

How Primary Care Providers Can Help Women Hurdle The “Roadblocks” To Their Care

A report just released on HealthReform.gov, the website for the Obama Administration’s healthcare reform effort, is entitled Roadblocks To Healthcare: Why The Current Health Care System Does Not Work For Women, and cites that more than half of American women (52%) delay or avoid care because of cost, compared to 39% of men.

A video synopsis of the report, hosted by Kathleen Sebelius, the Secretary of Health and Human Services, states that women are being left behind when it comes to healthcare and that there are over 21 million uninsured women in the U.S.  Young women have much more difficulty finding affordable health insurance than do men and often pay higher premiums – sometimes one and a half times – those of a young man. These facts all add up to women not getting the care they need to stay healthy.

As a primary care provider (PCP) focusing on women’s health, the findings of the report don’t surprise me, not even a little. From my anecdotal studies of the number of women that I have seen over the years, the majority of women struggle to receive the care they need because they cannot afford it. What typically will happen is that these women delay, often for years, any type of check-up or preventive care because of costs. Instead, they wait until they are sick or are having issues, and then they are forced to find the money and the time to seek medical care.

I also have found another factor beyond price that is creating a barrier to healthcare for women,  and the word is “convenience.”  Many women cannot, or often will not, take the time to seek routine medical care when most doctor’s offices are open, which is nine to five. Frequently these women are working, albeit on jobs that offer them little or no healthcare coverage, and are loathe to take time off of work for a non-emergency medical issues. Women also have the lion’s share of childcare responsibility, and are more likely to put their children’s schedules and family needs well before theirs.

Primary care can be the first place to look for a solution in bringing affordable, convenient care to women so that there are no roadblocks to access. We strive to do just this at our practice. Our Well Women Clinics were spearheaded after much deliberation about cost and convenience.  We started last year and have found them to be a great success. For these clinics, we designated specific days during the month for routine well women check-ups. Hours for these check-ups are early morning through lunch one day and mid-afternoon through evening on another days. We offer the clinics two days each month on different days of the week, ideally making times available for each patient’s schedule, whether she is a current patient with us or a new one.

Although the biggest hurdle for women to getting the care may be cost, as the Obama Administration’s report cites, let us not forget the role that convenience in getting this care plays. Healthcare and wellness does not have a nine-to-five schedule. Likewise, most women’s roles beyond possibly those in a regular “office” job are not on such a regimented schedule; their roles as caretakers and mothers have round-the-clock demands. We need to work with women determine and then remove all of the roadblocks to accessing of care, starting first and foremost with cost, moving to convenience and then considering others that may exist.

Until next week, I remain yours in primary care,

Valerie Tinley, MSN, RNFA,  FNP-BC

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