Have HMOs improved or undermined patient care in America?

Undermined

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by Shawn Borin

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For the past few decades, Healthcare has been a national issue. Every politician promises to fix the healthcare system to ensure that everyone has good and reliable health coverage. I agree that this is an important goal, but what about those who now have healthcare coverage but are getting nothing for the thousands of dollars a year in premiums paid. There can be no doubt; HMOs have undermined patient care. For proof, I detail my own experience with the American HMO system.

In early December, I began experiencing severe abdominal pain. More than the average tummy ache, this pain had me crying in pain. As it was five o'clock in the morning, my only option was to go to an emergency room.

I am an attorney. The firm I work for provides health coverage and I pay nearly $400 a month in premiums. I believed that my family and I were covered. So while I lay crying in pain on my couch I decided to wait until my Doctor's office opened in the morning because I did not want to pay $150 co-pay for emergency visits. I knew calling my doctor was out of the question because that office does not open until 9. Because of the current state of the HMO system, you can only get sick during business hours or have to shell out hundreds of dollars to see a doctor.
So I sat in pain until 9. Then I called. At first they said the next available appointment was over two weeks away.

They said if it hurt that much I should go to the emergency room. After over an hour of my persisting, I got an appointment for later in the afternoon. So I showed at 3 p.m., paid the $30.00 co-pay and saw my Doctor. Actually, it wasn't my doctor; he left a few years back. So now I have a new doctor. She spends a total of five minutes then says I should see a specialist. She said it would take over a week to get a referral but in the meantime should would have me get blood tests and Abdominal CTs. The blood tests were easy enough, but the CTs were booked until after Christmas. In the meantime, I should just rest and not eat much until they can figure it out. One week and 7 phone messages later, my Doctor finally told me the referral went through. My next appointment is January 14.

Blood tests show Crones disease, not that anyone has explained to me what this means. So I have missed a bunch of work, paid out hundreds in co-pays and Rolaids and I am in no better position than I was. I guess the emergency room would have been a better option but I always thought the emergency room was for people suffering heart attacks, strokes and other near death incidents. Guess it is the only way to get efficient medical care these days. Can this really be the way it is? I pay my premiums and hardly ever see a doctor. Yet, the one time I do I am in a constant state of waiting, with no one explaining to me what is going on. I could not imagine having cancer and being treated like this. So how can fix this system? I really have no idea.

Perhaps the problem is medical care has become a big business and run like such. It seems to me the system has doctors seeing as many patients as possible without spending time with any. It seems that referrals and tests are delayed in the hopes that they will be forgotten. Because of the need to see patients, doctors do not follow up with the patients they just saw. No phone calls, no nothing. If you want to talk to a doctor, you have to go into the office so they can get the next co-pay. This is a direct result of the HMO system itself. I do not believe doctors can be happy existing in this world.

How can you take money out of medical care? Doctors and nurses deserve good salaries and the money has to come from somewhere. Hospitals need technology and good staff, so the money has to come from somewhere. I for one don't mind paying the premiums and co-pays as long as I am getting my moneys worth. But that is not happening. If I could, I would change doctors but apparently this takes over a month to do and needs massive paperwork to complete. I can't send it back like a bad meal. There are no return counters. What can we do? All I know is the system needs to be fixed as the current system undermines patient care. The current system creates financial and timing barriers to actually seeing any doctor, never mind your own doctor. I also know I have no ideas on how to fix the problem. Thanks for reading.

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