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Social Health And Patient Empowerment: Are We In A Bubble?

I regularly talk to my patients’ parents about social health. What parents do, what they think, and how they socially experience their child’s health problems has become an interest of mine.

I can hear it now: “Of course patients won’t discuss their social health activities with you, you’re a doctor.” Perhaps, but I don’t think so. Actually, I’ve had some very interesting open dialog with a few of my long-term patient-parents. Many have children suffering with chronic diseases such as Crohn’s disease, eosinophilic enteropathy, and the like. The relationships I cultivate are open, and the nature of my dialog has been just as consistently open as other aspects of our relationship.

Interestingly, while nearly all have used online search to understand their disease, most have never connected with other disease sufferers in the online space. The concept of crowdsourcing is met with puzzled looks. Sure they’re e-patients, but I would characterize most of my patients as e-patients. The question is: What does that really mean? Read more »

*This blog post was originally published at 33 Charts*

A Significant Pediatric Moment

I hate pediatrics. People who don’t understand the life of surgery may think this means I don’t like children, but in fact the contrast is true.

Surgery is suffering and heartache. Surgery is pain and misery. It’s stuff children aren’t supposed to experience.

Children are supposed to be caught up in the joys of life. They’re supposed to play and smell the roses along life’s paths. Pain will come later, but childhood is supposed to be a sanctuary, albeit temporary from the harsh realities of life. And when life gets harsh, they may need to come to me.

I once spoke about a very special boy who crossed my path. His death still haunts me, but there was another incident which drove the wedge between myself and pediatric surgery forever. Read more »

*This blog post was originally published at other things amanzi*

Hawaii Learns Tough Lession: Free Childrens Health Insurance Program Abused By Wealthy Parents

Fascinating commentary on human nature. Thanks to Grace-Marie Turner at the Galen Institute (this excerpt is part of an article published in the NY Post today):

HAWAII just had a vivid les son in health-care economics, learning that if you offer people insurance for free – surprise, surprise – they’ll quickly drop other coverage to enroll.

As a result, Hawaii is ending the only state universal child health-care program in the country after just seven months.

The program, called the Keiki (Child) Care Plan, was designed to provide coverage to children whose parents can’t afford private insurance but who make too much to qualify for other public programs (such as Medicaid and Hawaii’s State Children’s Health Insurance Program). Keiki Care was free for these gap kids, except for a $7 office-visit fee.

But then state officials found that families were dropping private coverage to enroll their children in the plan. “People who were already able to afford health care began to stop paying for it so they could get it for free,” said Dr. Kenny Fink of Hawaii’s Department of Human Services.

In fact, 85 percent of the children in Keiki Care previously had been covered under a private, nonprofit plan that costs $55 a month.

When Gov. Linda Lingle saw the data, she pulled the plug on funding. With Hawaii facing budget shortfalls, she realized it was unwise to spend public money to replace private coverage that children already had.

Yet Lingle is facing a political firestorm in the state from critics who say that she’s denying children health insurance – notwithstanding the fact that children in Hawaiian families earning up to $73,000 a year are eligible for Medicaid…

The Hawaiian debacle should also be a caution to Barack Obama, who wants to mandate that all children have health insurance. This would plainly not only require penalties for those who didn’t comply but also new programs to help parents get their children covered. The risk of crowd-out will be great.

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