Well the past week has not been fun for the Reaching Our Balance family. First, Mrs. ROB was diagnosed with pneumonia, then I was diagnosed with pneumonia, and recently we had a much larger medical issue that I will be talking about in greater detail once we have more information and some things are sorted out.
Let me say that the medical care we have received has been great. But it got me thinking into all of the changes in healthcare over the past few years with Obamacare, the costs of healthcare, innovations in delivery of care, etc. And I just thought I would talk about a couple of things that we have used and worked well for us, plus a growing alternative that some people might try.
This is NOT an anti-insurance rant. In fact, going without insurance is something you shouldn’t do. It really is a necessity, even if you are young and in good health. At least have some kind of coverage, even if it is a disaster insurance plan. This is also not a rant about the need for universal coverage and the like. Although that maybe the path we are going and more of what I might prefer I don’t think it will happen all that soon.
I am talking more about the delivery of healthcare, rather than insurance (but that will be a post soon…promise).
Delivery Option #1: Minute Clinics
A few years ago CVS/Caremark started opening up a variety of small clinics inside their stores across the country. I think Wal-Mart and some other major retailers have opened up similar facilities. The idea was the Minute Clinics would be able to “unclog” some doctors offices and take people who might need help with small items like the Flu or a Cold, and Earache, etc. Tom Ashbrook, host of NPR’s On Point, had an excellent show on the subject earlier this year. There are some people who argue that Minute Clinics are not good medicine. It interferes with people going to their doctor. It is a “cheap” version of good medicine.
I am not sure if any of those complaints are really true, but I can tell you that the two or three times I have used a Minute Clinic has been great. The nurse practitioner was knowledgeable, nice, and efficient. I didn’t have to go to the doctor. I got my prescription and it was done in 45 minutes. It saved me a trip to the emergency room for something that wasn’t an emergency.
Unfortunately, when I mention Minute Clinics to some I am met with some suspicion. Some people feel like their experience isn’t good unless they see a physician. I found that to be the exact opposite. And I encourage people to use them for small ailments (e.g. the flu, an earache, etc) or some other small item so they don’t have to go emergency care. I only had to pay my co-pay. For me, the Minute Clinic experience made me an advocate.
Minute Clinics are NOT available at every CVS and depending on where you live they maybe difficult to fine (particularly in rural areas). However, there might be another ‘minute clinic’ at a big box retailer or something of that nature. I am not sure of the quality of the care there but it might be worth at least taking a shot with.
Option 2: Urgent Care
A second option that Mrs. ROB and I have used recently has been Urgent Care, which I guess is somewhat of a substitute for an Emergency Room. Now Urgent Care seems to be for some more advanced items like needing x-rays, diagnosing for pneumonia, etc. There are a variety of medical things they can help you with. They can certainly do much more than a Minute Clinic and look very much like a normal hospital/doctor’s office.
The idea of Urgent Care was to cut down on people going to the emergency room when perhaps their ailment wasn’t a real emergency. Generally, I was pleased with my experience at urgent care. They handled everything very well and I only had to pay my normal co-pay for a doctor’s visit. There are a couple of downsides to Urgent Care. I am not sure about the convenience, but it doesn’t seem like they are that conveniently located, at least where we live. I had to actually drive a bit to get to one. Second, the hours of Urgent Care are basically the hours of a retail store. The one we went to had hours of M-F hours of 8-8, Sat, 8-4, and Sundays 8-4. However, I have seen shorter times during the weekdays and weekends. I certainly understand that. I mean they are not designed to replace Emergency Rooms, but it can be somewhat inconvenient for people.
Now another option that I fully admit I have not tried, but read a bit about is the notion of paying cash for your health care. One of the big complaints among many people is that healthcare seems to be a bit of an assembly line. Doctors have too many patients and too little time. As a result, there has been a growing call and desire for concierge care. The advantage of a concierge system is that you provide doctors with an up-front payment, sometimes monthly payments, and in-return you get a doctor who make house-calls. Think of it like Doc Baker on Little House on the Prairie. The USA show Royal Pains is based upon this kind of care.
Despite what is portrayed on TV, concierge care, from what I have read can be somewhat reasonable. It does require an upfront cost for most people, but more doctors are taking on a bit more patient load and going to more of a gym-style payment system. In other words, they charge you a monthly fee for some basic services.
Typically, in concert with concierge care you have a high deductible insurance policy that can be used for any medical emergencies/hospital care. That deductible can run in the thousands of dollars, but more people have access to Health Savings Accounts (HSAs) that they can use to stash away money (like saving for retirement) that you can use to pay for the deductible or the fees to the concierge service.
Moreover, some places will allow you to negotiate surgery prices. Sometimes with a high deductible policy, if your surgery cost is fairly low, you will have to pay totally out of pocket and your insurance policy is useful. If you can negotiate surgery ahead of time (and a lot surgeries you can’t….I am not talking about cancer or brain surgery, but something outpatient like knee surgery or something) you might be able to save some dinero. Kiplinger’s Personal Finance has a pretty good article on the subject here.
Now don’t get me wrong there are some downsides to this kind of delivery of care. First, it requires some kind of up front payment that some may not have access too. However, as I mentioned more and more concierge places are going to monthly membership systems that can run, according to Kiplingers, as low as $60 a month.
Second, you need to have insurance, at least a high deductible policy, it would seem for this kind of stuff to work.
Third, you would need to have access to this kind of care. At my position, I am not even given the option of a choosing a high deductible option and the use of an HSA.
Fourth, this doesn’t work for a lot of people. For example, this type of care could work for me. I tend to be fairly healthy and don’t get sick much (save for this past week). However, for someone like Mrs. ROB, who has more medical issues than I do and some pre-existing conditions it probably doesn’t work. And that probably is the case for a good chunk, if not the majority, of Americans. As long as I am married to Mrs. ROB (and I don’t think we are planning not to be together anytime soon) I will be a normal health insurance user.
Ultimately, this post hasn’t been about advocating for a particular kind of care, but to really share with you an experience or two and demonstrate that there are alternatives to going to doctor and/or emergency room for every single ailment. Certainly, these options are not for everyone, but I know that we will continue to use the first two options and the third could certainly be a substitute for some than our traditional delivery of care in the United States.
What do you think?