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Thursday, 9 May 2013

Your Health Care System At Work-A Primary Care Conundrum


Your Health Care System At Work
Today, at 9:00AM I received a call from the school nurse indicating my sixteen year old son was in her office with a very low heart rate (in the 40’s). This in and of itself was not that distressing to me since my resting heart rate was 52 in my twenties,  and it is a family trait. However, between the time I received her call and attempted to contact my son’s primary care provider, I received another call indicating that his heart rate was so erratic they had called 911. The triage system then required that he be evaluated by the fire department paramedic and transported to the local emergency department. Once there, he was admitted and then evaluated with X-rays and other diagnostic equipment. In the meantime, I had called my primary care provider at Washington’s Community Health Plan three times, was on hold for 15 minutes, and been patched through a “call center,” all the while never having spoken with a clinician. So, the delivery of “primary care” to my son was handled by non-primary clinicians, because the primary care provider was not available.
This scenario illustrates one of the problems in our health care system, which is we have a shortage of primary care clinicians.  It is important to note this reflects a dearth of doctors who are willing to work within the basic pediatric reimbursement level, so the patients are forced to pursue other health care options, AKA the emergency department of your local hospital. This method of treatment is of course expensive and abhorred by health care policy analysts, but when you do a root-cause analysis, this pattern is informed by the lack of treatment options for basic health care in the USA.
This scenario happened in Washington State, which is fairly well off financially, and it concerned a child of a parent well versed with the health care system, so you can imagine how this plays out for ESL parents or others with less familiarity. In Washington, Virginia Mason Medical Center has excellent primary care and a  high level of patient safety, based on their Leapfrog Patient Safety evaluations, their Malcolm Baldridge Quality Award, and personal experience. However, the Virginia Mason system is not available to everyone, especially outside the Seattle area. So, where do the children of parents who are not covered under the luxurious private health care system or the realm of Medicare obtain their basic health care? More than likely they have deferred health care, which is to say very little. I can remember going through at least one Minnesota winter with untreated bronchitis, in a district with no school nurse, and with parents who were barely getting by.
  All of this relates to the lack of basic health care for children, a pattern that hasn’t changed in decades. Though the Children’s Health Insurance Plan (CHIP) which provides federal funding for children who are in the lower economic rung of our society ( which turns out to be quite a few at 7.6 million in 2010 alone) has indeed expanded health insurance coverage for acute care for children, has it increased access to primary care?
The problem with primary health care in the United States is it is so reimbursement driven that the patients experience many obstacles to obtaining timely care. In the case of my son, even with the ED intervention, the soonest the “health plan” could see him was several days away. And the Children’s Health Plan is one of the country’s most well-funded programs. Imagine how it is for adults.
Also, nationally children’s hospitals are the most well funded facilities in the country, monuments to our willingness to throw money at the most dramatic health care interventions, but lack of national motivation to provide accessible basic health care for the country. Do we need to have traumatic injuries or cancer to gain access to the best health care in American, it would seem so.
Anyway, the next time you don't approve your school bond issue, think about the lives that are at stake and this is the healthpolicymaven signing off.
This article was written by Roberta Winter, MHA, MPA, health care journalist and advocate.


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