It's been a long week. I've been on call for our practice, which means that I'm responsible for all the adults and children requiring hospital care from our practice. And it's been, unfortunately, a typical week - busy, with some very ill patients, many of whom are uninsured or "underinsured".
I am caring for a middle-aged woman who presents with chest pain, so she gets admitted to me to be sure that she hasn't had a heart attack. (yeah, there are cardiologists in our hospital, but they don't do this kind of work...) And, oh by the way, she is actively suicidal. (yeah, there are psychiatrists in our hospital, but they don't do this kind of work... sensing a theme here?) I was able to have her seen by one of our psychiatrists, who started her on therapy. She has no evidence of heart disease, and so now she sits on the medical unit due to her depression and suicidality. (We do have a psychiatric unit in our hospital, but... you know what I'm gonna say! - When I inquired about her being cared for on the psychiatric unit, the immediate response was, "Well, she's uninsured, so...".)
I'm seeing a young man, a man who works hard in a physically-demanding job. He's been ill for more than a month. He went to the Emergency Room when he got sick, and they treated him for pneumonia. He was asked to follow up with one of my partners in our office, but he couldn't afford it. (We are not a free clinic, but we charge people based upon their ability to pay, so the fee for the office visit may be as low as $20.) Since he couldn't afford to see us in the office, he had to go back to the emergency department a few days ago, having gotten more and more sick. He has been in the hospital all week with a severe pneumonia. He's worried about how long he might be off work, since if he doesn't work, he doesn't get paid. He'll need a month of antibiotics, which would cost him only about $350 at a local pharmacy. "That's almost what I pay for rent," he says. The owner of the small business for which he works doesn't offer him health insurance; he's been on a waiting list for Washington Basic Health Plan for two years. Let's see, two emergency department visits, two CT scans, four or five chest xrays, inpatient care for ~ a week, with antibiotics and oxygen.... that's likely to be, I would guess, $20,000. How many of us can cough that up? How long will he be paying for this? Oh, and he doesn't smoke. This clearly isn't a case of an error in judgment, "personal accountability" - it could have been any of us with this course.
You know, you can find some information now on the web showing the costs of care for various diagnoses at your local hospital. At this site, I see that the average cost for my local non-profit community hospital. Uncomplicated pneumonia: $8,100-11,400 - "33% lower than national average." This young man surely has costs higher than this average, given the severity of his disease and the extra tests and time he's had to have. I'm also interested to see that the website indicates the services available at the hospital, starting with Behavioral Health / Mental Health / Substance Abuse Services. It looks like they forgot to add the asterisk, which points to the fine print: "...some services only available if you have desireable insurance status, and not available at all to the uninsured in our community."
Let me add this comment here. The words here are my own ramblings, and do not necessarily reflect the opinion of my employer or those with whom I work.
Well, back to work. I have to see some more patients after my lunch break.