Navigating healthcare

By Diane L. Marolla, LICSW

Are you choosing wisely when it comes to your healthcare?

“The first wealth is health.” — Ralph Waldo Emerson

It is now the year 2020, and I have worked in the healthcare field for thirty-three years. I would like to say that for the healthcare consumer (and all of us are healthcare consumers) that navigating healthcare is easier and less expensive, but that is not that case. In the “old days” we were given a health plan through our employer. Our employer paid for it, and we didn’t have co-pays or deductibles (yes, I am old enough to remember these days). In the mid to late eighties, employers recognized that “free” health insurance plans would not be financial sustainable, therefore, employers started requiring that their employees pay health insurance premiums through their paychecks. Deductibles and co-pays became the norm. As time has progressed, our premiums, deductibles, and co-pays have increased, and our coverage is less. The managed care organizations (health insurance companies), have become more and more powerful and profitable. It is the managed care companies that decide how care will be delivered to us, by whom, and how much it will cost us (although they deny this). If we don’t agree with their policies, they won’t pay for our care, and we will be left paying the bill. Now, more than ever, it is important for us to become more educated about our healthcare and to do everything possible to stay healthy and ask questions, or else it can cost us thousands of dollars or even bankruptcy.

Recently, I learned of a free consumer education campaign in Rhode Island that can help all of us make better health care decisions and ask the right questions when we are sitting with our doctors. The campaign is called Choosing Wisely. I recently spoke with Joanne Bilotta, Choosing Wisely-RI Campaign Manager and Board Member of the Rhode Island Business Group on Health (RIBGH), about the campaign in Rhode Island. Joanne informed me that it was the American Board of Internal Medicine Foundation (ABIMF) that launched the Choosing Wisely campaign following research conducted by the National Academy of Medicine that determined over 30% of the healthcare dollars spent in the United States are for unnecessary tests and treatments and the results of their own survey which found the following troubling facts:

“Physicians felt pressured by patients to prescribe unnecessary tests or treatments and feared lawsuits or losing patients if they said no.”
“Physicians lacked the tools to have conversation with patients.”
“Patients felt uncomfortable asking their doctor questions.”

The Choosing Wisely campaign is an international campaign active in 20 countries. In Rhode Island, this campaign is growing rapidly and is supported by RIBGH and their 90+ RI employer members, RI Medical Society, Hospital Association of RI, Governor Raimondo, United Way of RI, and the RI Foundation. The Choosing Wisely campaign is designed to empower consumers to become engaged in their healthcare decisions and treatment options by asking their health care clinicians the following questions:

Do I really need this test or procedure?
What are the risks and side effects?
Are there simpler, safer options?
What happens if I don’t do anything?
How much does it cost and will my insurance pay for it?

Why are these five questions important to ask? Here are recent and startling statistics from the October 7, 2019 communication from the Journal of the American Medical Association (JAMA) Waste in the US Health Care System: Estimated Costs and Potential Savings that might surprise you:

The United States spends the most money on healthcare than any other country.
30% of our healthcare spending is considered waste.
$75.7 billion to $101.2 billion of healthcare dollars in the United States is spent on overtreatment or low value care.

The terminology “low value care” was a term that Joanne mentioned to me in our conversation about the Choosing Wisely campaign. What does low value care mean? Simply stated, it means that it is medical treatment, tests, medical procedures and medications that aren’t necessary and can often be harmful to patients. You may be saying, but surely this can’t be the case, but it is true. Think of the opioid epidemic and the thousands of lives lost in this country because patients were prescribed opioids for pain and were unaware that the medications were addictive and deadly. According to the Center of Disease Control, from the years 1999-2017 a total of 702,000 Americans have died of drug overdoses. Specific to unnecessary medical tests, an online article published by the National Center for Biotechnology Information (ncbi.nim.hih.gov) states “Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures.” According to the Center for Disease Control “about 30 percent of antibiotics, or 47 million prescriptions, are prescribed unnecessarily in doctors’ offices and emergency departments in the United States, which makes improving antibiotic prescribing and use a national priority.”

As we enter a new decade, all of us need to make a conscious effort to be better healthcare consumers by taking better care of ourselves and asking more questions when it comes to our healthcare.

To find more information about the Choosing Wisely campaign in RI go to https://www.ribgh.org/choosing-wisely-ri. There are also over 110 free patient friendly materials available at www.choosingwisely.org/patient-resources to help patients decide when a procedure, medication and treatment is necessary or not.