US medicare: Delays, denials and high costs

The US boasts of advanced medical technologies and systems, but procedural formalities, high costs and insurance domination frequently overshadow the quality of care. Systemic failures such as fragmented healthcare systems and lack of coordination as well as cost burden, which limits accessibility for many in USA, are a BIG CONCERN. Medicare is often delayed beyond expectations

In the recent past, frequent visitors to USA, by and large, appear like having bizarre experiences, and apprehensions regarding medicare and medical errors there. One such acquaintance of mine, a psychiatrist by profession and Green Card holder, narrated the ‘Zigzag Medicare’ being provided not only to frequent visitors like him but also to visitors on multiple entry visa, and for that matter even to permanent residents as far from satisfactory.

Medical errors, expensive medicare, insurance domination, over dependence on Artificial Intelligence, apathy of specialists regarding post-operative and post-medical care, absence of attending on patient by qualified physician even in emergencies, shifting the responsibility on a nurse etc., are of concern.

In essence, medical expenses are not only costly, but care is also often delayed beyond expectations due to unnecessary procedural hurdles. If it was insurance domination earlier, gradually it moved to excessive dependence on AI from admission stage to referral stage and finally treatment stage. ‘Except Speech, Nothing is Free in USA’ is the broad opinion of many.

Medical error is defined as an ‘Unintended Act of Either of Omission or Commission, or one that does not achieve its Intended Outcome’ whether emergency or non-emergency medicare. It is caused by inadequately skilled staff, error in judgment or care, a system defect, or a preventable adverse effect. This may be due to computer breakdowns, mix-ups with the doses or types of medications administered to patients and surgical complications that go undiagnosed. Ultimately, ‘It is the system more than the individuals that is to be blamed’ according to experts.

According to Ray Sipherd, taking cue from Johns Hopkins study, ‘The Third-Leading Cause of Death in US’ was that most doctors do not want either the patient or their attendant to know about the medical errors. Another article ('Your Health Care May Kill You: Medical Errors’) in ‘The National Center for Biotechnology Information’ of ‘National Library of Medicine,’ by James G Anderson and Kathleen Abrahamson, also expressed a similar view. In their view, ‘Medical Error Rates’ are significantly higher in the USA than in other developed countries such as Canada, Australia, New Zealand, Germany, and the United Kingdom.

Existing medicare in USA for immigrants, irrespective of Green Card holders or routine visitors, the negligence in treatment remains the same. In fact, an insurance coverage from a reputed and reliable Indian insurance company is thousand times better than any other modality there. Unlike the emergency care in either government or private hospital in India, where there will be some physician who is essentially available always, the initial emergency care in USA, however high volume of emergency it may be, is handled by a qualified nurse.

It is only after the basic information from the patient is collected by the nurse, such as first name, last name and insurance., the time for which would normally vary between an hour to two, and feeding to AI, the patient will be referred to a duty doctor as suggested by it. He or she in turn will refer to the specialist concerned as the case may be. These days, it is said that many young doctors are preferring these eight-hour easy duties because of handsome payments, with less responsibility. Once the patient admitted, the specialist does his or her job as required, and unlike in India periodical visits during post-surgical or post-medical treatment are seldom done.

An interesting story my psychiatrist friend narrated to me was about the plight of a senior obstetrician and gynecologist, whose son had a serious wound on his forehead, and how she moved from pillar to post for his treatment because of procedural delays. She could not even prescribe a painkiller tablet, despite being a doctor, because it was someone else’s job. Ultimately, another surgeon friend came to her rescue.

This reminds me of the scenario in India. Six-seven decades ago, during my childhood and later for some time, minor, medium, and marginally major ailments for any villager were taken care of by a ‘local self-styled doctor or quack’ often referred to as RMP (Registered Medical Practitioner) or LMP (Licensed Medical Practitioner). The ‘Quack’ was respectfully addressed by his name by prefixing ‘Doctor Saab.’ Some of them would have undergone the three-year authorized diploma course, whereas many start practising by ‘hook or crook’ and gradually acquire expertise, by and large faultlessly.

From there we moved to a stage, where just an MBBS (Bachelor of Medicine and Bachelor of Surgery) graduate or at the most MD (General Medicine) or MS (General Surgery) doctor rendered service to the satisfaction of patients. Then, patient’s history taking by the doctor himself or herself was an important and initial component of consultation. The patient was invariably allowed to narrate his existing primary health complaint and details in his words and then it was followed up with asking some pertinent questions by Doctor.

The ‘Clinical and Physical Examination’ of patients by these doctors comprised of ‘Inspection’ (looking at the body), ‘Palpation’ (feeling the body with fingers or hands), ‘Auscultation’ (listening to sounds, usually with a stethoscope), and ‘Percussion’ (producing sounds, usually by tapping on specific areas of the body) in that order. Percussion was very useful part of ‘Clinical and Physical Examination’ to know the presence of collection of fluid, air in the body by eliciting dull or resonant sound. This was done by tapping the doctor’s finger placed on the patient with a finger of the other hand. They then followed up treatment based on their diagnosis, which was entirely attended to by the doctor personally. These included giving injection, seeing BP etc. The patient was immensely satisfied for the personal touch of doctor those days.

With gradual westernization, and with the advent of specialist, super and multi-specialty doctors, even for a small ailment, there are separate specialists. ‘Clinical and Physical Examination’ has become a rare phenomenon. Health care delivery tells of contrasting health care systems with their own way of approach. In India, the system despite ‘Shocking Changes’ still remains ‘Acceptable’ due to its ‘Affordability’ and increasing efforts to improve ‘Accessibility.’ The USA may provide high-quality care but at a prohibitive cost. It is not insurance linked or dominated expensive health care for the gifted few that we need. Health care of patient’s choice is important.

Despite a few drawbacks, medicare in India, whether superior or inferior, assures ‘Availability, Accessibility, Affordability, and Acceptability’ by and large. If a medical error is committed, prompt corrective measures are easy, compared to USA. The psychiatrist friend of mine, before leaving for another USA visit, agreed with me!!!

The USA boasts of advanced medical technologies and systems, but procedural formalities, high costs and insurance domination frequently overshadow the quality of care. Systemic failures such as fragmented healthcare systems and lack of coordination as well as cost burden, which limits accessibility for many in

USA, are a BIG CONCERN. Similarly, overreliance on technology leading to inexplicable errors in electronic health records or overdiagnosis due to advanced tools is yet another BIG CONCERN. But these are ‘Necessary Evils.’

In contrast, India’s healthcare offers affordability, acceptability and patient-centered approach. For many, seeking treatment in India, perhaps, provides greater reliability and peace of mind than navigating the complexities of USA medicare. It ensures quality healthcare with emphasis on the principles of Availability (Adequate infrastructure and workforce), Accessibility (Physical and economic reach of services), Affordability (Cost-effective care to prevent financial hardship), and Acceptability (Respect for cultural, ethical, and patient-specific preferences). Doctor-patient relationships for a personalized care rooted in cultural understanding dating back to ages is the Indian specialty.