Sunday, April 23, 2006

Preventative Medicine in a Chronic World: The Illogical Logic of Health Care

You only need look on the cover of any number of mainstream magazines or flip through the newspaper to see how much discussion there is about chronic illness in our country. Football stars appear in television ads for asthma prevention, and well-packaged ads plugging medications for long-term conditions grace our screens so often nowadays that I can recognize their corresponding theme music from the other room.

With this increased awareness of chronic illness is an understanding of the economic impact of such long-term medical problems. Lots of people are living longer and living with conditions that require a lot of care. According to the Healthy People 2000 Final Review, put out by the Department of Health and Human Services, the direct medical and annual costs attributed to these conditions total more than $3 billion, or four percent of the nation’s gross national product.

That’s a whole lot of money at stake, and as much as I hate to admit, the business of health care is, above all else, a business. Does that strike anyone else as a monumental—and inevitable—conflict of interest?

The logical thing would be to provide as much preventative care as possible, right? The more we can control our symptoms and the progression of our diseases, the less likely we are to need longer hospital stays, costly surgeries, and additional medication. It’s a win-win situation—we are healthier and happier patients and insurance companies save money when they don’t have to cover skyrocketing hospital bills and expensive procedures. Overcrowded and overworked hospitals would even benefit if chronically ill people like myself weren’t always clogging their wards.

But it doesn’t work like that. Let’s take the example of my daily chest physiotherapy (chest PT) since I’m currently embroiled in a messy battle to get it covered. Chest PT involves a vigorous “clapping” the lobes of the lungs in eleven different positions by a trained professional to dislodge the mucus that collects in the lungs. Since my lung diseases mean mucus and infection build up in my lungs each day, chest PT is an essential component of my treatment plan—without it, my infections linger longer and get much worse, often leading to respiratory distress or even respiratory failure.

Before I got correct diagnoses for my lungs and I didn’t have chest PT, I spent weeks and weeks in the hospital each year, including stints in the ICU for collapsed lungs and pneumonia. Let me tell you, several days in the ICU and multiple x-rays, procedures, tests and monitors doesn’t run cheap. Multiply that by several trips, and it runs into thousands and thousands of dollars.

You’d think then, that my insurance company would rather pay for the much-cheaper daily chest PT and help keep me healthy than wind up paying truly shocking amounts of money when I am constantly in and out of the hospital. Surely such a sound preventative measure makes sense both financially and in terms of common sense.

But no. I’ve changed health plans five times in seven months due to employment changes, and each time I switched, the worse it got. One company refused to cover any chest PT after two weeks’ worth of sessions, and another wouldn’t even do that. It offered to send a therapist out once to train a family member, leaving arguably the most critical part of my treatment plan in the hands of well-meaning people who didn’t know how to use a stethoscope or locate any of the lung’s lobes.

After months of phone calls, faxes, and letters of medical necessity from my doctor, I finally won a battle, but winning the war is looking increasingly futile. I have coverage for three sessions a week for four months, but since they decided to apply it retroactively, I really only have coverage for another month. After that, no one knows what will happen, and even with this small victory, my husband and I have already shelled out $2100 towards chest PT in the past several months.

I wheeze more, I’ve had more viral infections and decreased oxygen saturation, and I’m running out of money—and I am still one of the lucky ones who even has health care. The chronically ill population is only going to grow—hopefully, there will come a time when attitudes towards our care with evolve with us.

5 comments:

Anonymous said...
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Laurie said...
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Colin Sullivan said...

Love your page!
I got here by following the link from www.chronicbabe.com. On that site I believe I'm the only male subscriber. I've just begun communicating with Jerri, hopeful that a project we've talked about comes to fuition.
I'm have Arachnoiditis, and worse still, Boston Irish.
I've got a site and would love to talk. Sorry to reach-out to you in this way, but I couldn't find your link. If you get a minute, drop a line at colinsu@msn.com.
Thanks, Colin

Dream Believer said...

Hi, I just stumbled across your blog while looking up information on chest PT for my son. Have you looked into The Vest? I understand all too well the insurance fights. (oh, how I understand) But as you know, persistence works... We just got The Vest approved for him and he uses it twice/day while healthy as a preventative and up to four times/day when fighting off "the crud". He also had full panels of all the IgG's run (not just the usual ones taken during bloodwork) and they found that a rare IgG is low and he now gets weekly IgG infusions. This is boosting his immune system and hopefully will cut back on the hospital stays and constant sickness he has experienced. Hopefully a couple of those ideas will help you out! Stay strong.

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