Do Insured Patients Get Worse Care?
I’ve noticed an interesting pattern among patients in my DPC practice. After obtaining health insurance coverage, their health unexpectedly declines. You may be thinking that these patients were delaying a diagnostic workup or preventative screening and that they received a new diagnosis once they could afford this testing. That’s a completely logical thought process, but, in this case, it’s not the correct explanation.
Believe it or not, my uninsured patients usually pay less overall for their care, and they don’t encounter any insurance roadblocks. It’s simple and easy for them to pay cash for the testing and treatment they need. The one preventative screening test that is not affordable for some of my uninsured patients is a colonoscopy, and some of them opt out of colon cancer screening for this reason. Luckily, none of my patients who have chosen to delay colonoscopy until getting Medicare coverage have been diagnosed with colon cancer.
The pattern I have repeatedly witnessed is that an uninsured patient with multiple stable medical conditions, which are controlled with inexpensive medications, will decide to see ALL THE SPECIALISTS when they get insurance because they assume that more care is better than less care. They think they should be seeing a specialist for every single condition like their insured friends. They think they are missing out on the new medications they’ve seen advertised. Everyone else has been binging on healthcare, and now that they finally have insurance, they are like new Netflix subscribers, ready to experience their All-Access Pass to The American Healthcare System. They inevitably end up seeing midlevel providers who order unnecessary testing and prescribe expensive prescription medications recommended by pharmaceutical reps, and these new medications cause side effects and interact with their other medications. Then they arrive back in my office in physical and psychological distress due to medication side effects and worries over incidentalomas discovered on imaging, which were never explained by those who ordered the testing. They also face the harsh reality that even when insurance “covers” medical care, patients often have to pay a sizable amount out of their own pockets, an amount which is often greater than the cash price for uninsured patients.
The most surprising discovery I have made during my time as a DPC physician is the irony that my insured patients receive worse and more expensive care than my uninsured patients.
Well if they decide to dump you, consider yourself lucky as they’d probably be a PITA to deal with anyways. The few “psycho’s ” I had could drive me nuts but the FP program director in the residency I was in had a nice remedy. Allow them to schedule monthly visits to “unload” and all will be well. Some of the psycho patients like that and some will try to get into other docs who will allow them to “drive’em” crazy when the patients get bored with their current provider. In the latter, it’s not your problem anymore and I’m am SO glad to be retired now.
Thank you for this article. It is eye opening and rings very accurate!