Home Health care provider Tips for Navigating the Health Care System

Tips for Navigating the Health Care System

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Veteran doctor and administrator offers advice on how to handle America’s bewildering medical-insurance complex

The US healthcare system is complicated, difficult to navigate, and can kill you if you’re not prepared, proactive, and knowledgeable. From finding good doctors to being able to afford medication, the hurdles can seem insurmountable.

So said David Wilcoxwho has spent nearly 30 years in a variety of hospital roles and recently authored a guide for patients, “How to Avoid Being a Victim of America’s Healthcare System.”

A recent survey of nurse staffing companies indicated that more than a third of nurses plan to leave their current jobs by the end of the year. | Credit: Getty

Wilcox, who holds a doctorate in nursing practice, has served as a staff nurse, critical care nurse, nurse administrator, hospital administrator, and has worked in healthcare technology. He believes his experience and inside knowledge can shed light on how patients can work for better outcomes when dealing with hospitals, insurance companies, drug manufacturers and medical staff.

I have interviewed Wilcox several times and edit these interviews to highlight information that may not be widely known and to help readers learn how to use this information to improve care and health outcomes.

Barbara Sadick: Recent studies have indicated that medical errors are the third leading cause of death in the United States, after heart problems and cancer. How can patients prepare before a medical procedure to reduce their risk?

David Wilcox: I have seen so many bad situations that could have been avoided if people had prepared for them by doing research. Always ask questions. Know exactly what a procedure entails, why it needs to be done, how quickly it needs to be done, and what recovery will entail. Remember that patients and doctors should be equal partners and that patients have the right to ask as many questions as they want or to refuse treatment.

“Patients have the right to ask as many questions as they want or to refuse treatment.”

Be sure to ask about doctors and hospital ratings. Good evidence-based sources are available to do this research (healthgrades.com for physician assessments and CMS.gov for hospital ratings). Don’t just “google” for information. There is a lot of misinformation on the internet. If you are lucky enough to know a nurse working at the hospital where you will be treated, ask which doctors are most popular. They’ve been watching and can tell you who consistently performs well and who should stay away.

A recent survey of nurse staffing companies indicated that more than a third of nurses plan to leave their current jobs by the end of the year. Additionally, the American Association of Critical Care Nurses says that about sixty-six percent of acute and critical care nurses plan to leave the profession altogether. In this overworked and understaffed profession where nurses are in short supply, patients may receive less careful hands-on care. The nurses have too many patients to treat at the same time. How can patients and families cope?

Patients who are able to do this need to ask a lot of questions. If they can’t, and even if they can, it’s wise to have a family member or friend who knows the patient’s situation to advocate. Patients and advocates should question anything and everything, including anything that looks or looks suspicious. Ask until you understand.

Medication errors occur in nearly five percent of patients. Before taking any medication, understand what it is and what it is for. This can be confusing because drugs have generic names and brand names. If the drug name begins with a capital letter, it is a brand name drug. If it starts with a lowercase letter, it’s generic.

Some of the medicines you are given in the hospital are the same as those you take at home. To reduce costs and if you have not been admitted to the emergency room, you have the right to bring your own medicines to the hospital, give them to the healthcare team and not have to pay fifteen dollars for a medicine against headaches.

Because nurses are overworked, you and your advocates should be friendly and polite, as this will get you better care. But if there is a problem, talk about it and ask questions. If you don’t get satisfactory answers, continue to insist or ask to speak to the nurse supervisor. If your nurse seems rushed and you can wait, ask her to come back when things have calmed down. It is a way to prevent medical errors. It’s not hard for an overworked nurse with too many patients to confuse one with another.

Every day, about one in 31 hospitalized patients has at least one infection acquired in a hospital or other healthcare facility, according to the Centers for Disease Control. What can patients and providers do to reduce this risk?

First, make sure everyone who enters the room washes their hands. This includes visitors, family members, doctors, nurses and other hospital staff. To prevent pressure sores, a patient should be turned or turned every two hours. Pillows should be placed between the legs to reduce pressure. The sooner a patient is safely discharged from the hospital, the less likely they are to be discharged with an infection.

You say Americans spent about $535 billion on prescription drugs in 2018. That’s twenty-five percent more than in 2010. Pharmaceutical companies have hiked the prices of their most prescribed drugs from forty to seventy-one percent between 2011 and 2015. here?

“A typical consumer in the United States spends more on prescriptions than consumers in any other country.”

Pharmaceutical companies say they need to keep raising drug prices to raise money for research and development of new drugs. But the government, not the drugmakers, funds a lot of research, either directly through research grants or indirectly through tax breaks. State-funded research is your tax money at work, but you’re still being billed over and over again. Since 1930, the National Institute of Health has invested nine hundred billion dollars in research. Despite this, a typical consumer in the United States spends more on prescriptions than consumers in any other country.

Being the largest health insurer and payer in the United States, Medicare, if able, could buy in bulk and reduce the cost of drugs. However, it is against the law to negotiate drug prices. If allowed, it would drastically reduce the profits of drug company lobbyists who pay politicians. In the 2016 election, pharmaceutical companies spent sixty-two million dollars funding and influencing candidates.

Another little known fact is that drug prices vary from pharmacy to pharmacy. This is because insurance companies are unregulated and pharmacy benefit managers set the prices you pay using discounts and coupons that benefit both pharmaceutical and insurance companies. To find the best prices, you can use the resource guide, Dr. David helpsand compare the price of your medications to Good reception to ensure you pay the lowest cost.

Congress enacted the Health Insurance Portability and Accountability Act in 1996 to prevent access to sensitive patient health information without the patient’s knowledge or consent. Since then, healthcare technology has grown tremendously, and it’s not hard for your information to fall into the wrong hands. What should patients know to prevent this from happening?

When your health information becomes publicly available, there can be serious consequences. It can be used by insurance companies to deny you coverage. Be aware that genetic testing kits like 23 and Me and Ancestry.com can test for genes that influence your risk of developing certain conditions.

These companies anonymize your data and sell or give it to researchers who can then identify you again. Insurers often seek information that allows them to deny coverage. If, for example, your genetic information shows a predisposition to a serious chronic disease, it could cause a health or life insurance company to refuse to insure you.

Before you decide to inquire about your genetic profile or request genetic testing, think seriously about why you want the information and what you are going to do with it when you get it.

The Consumer Financial Protection Bureau reports that in 2021, American consumers owed more than eighty-eight billion dollars in medical debt. The figure is probably higher because not all debts are reported to consumer agencies. What should people do when they find themselves owing out-of-pocket expenses for health care?

Many Americans are living in crisis from a health emergency. If you find yourself in a position where you pay out of pocket for medical care, speak with a hospital finance office. You may be eligible for complete forgiveness of your debt or you may come to an arrangement to pay it off over time.

If you make a good faith agreement with the hospital and pay anything, regardless of the amount, on a regular schedule, your creditor cannot turn your bills over to a debt collector. But don’t miss a single payment. If a debt collector obtains this information, it will affect your credit rating.

Never take out a loan or use a credit card to pay off your debt, as this will cause you to take on more debt in interest charges. Negotiation is the key.

Recent analysis by the Commonwealth Fund shows that the United States ranks only seventeenth in the world in terms of efficiency, results and equity of health care, despite spending significantly more than others rich countries. Do you see that changing?

In our current fee-for-service system, the health care provider only makes money when a patient shows up sick, so there’s no incentive to keep you healthy. In a value-based model of care administered by an Accountable Care Organization (ACO), physicians receive a set amount each year for your care. If you become ill and end up in hospital, your doctor will have to pay additional costs. It’s an incentive for doctors to keep you healthy, and while some doctors are part of these ACOs, hopefully we’ll see healthcare continue to move in that direction.

Barbara Sadist is a freelance health writer whose articles have appeared in the Wall Street Journal, Washington Post, Chicago Tribune, Kaiser Health News, AARP, Cure and others. Read more