Should managed care sue patients?

We arrive at the dawn of yet-another health reform effort with laws and regulations already in place to protect patients. These arose in past decades when the healer-patient relationship was eroding, presumably at the hands of uncaring clinicians and for-profit medical enterprises.   

The list of those rights was extensive and today’s debates are adding to the mix – guaranteed coverage despite pre-existing conditions comes to mind. The discussion of patient rights has always been politically attractive and I won’t denigrate any one of them. I’m not just writing from a policy perspective, but a personal one as well. I’m a patient, too.

The discussions of patients’ rights, however, has neglected the flip side of rights—responsibilities on the part of patients, and the support that we all need from our communities to be healthy people. Today’s healers are beset with immense responsibilities, yet with few reciprocal rights of their own in their relationships with patients or communities.

As patients, communities and a nation, we all too frequently fail to follow medical advice or practice healthy behaviors, and yet expect that helath care will ‘make it right’ when we become ill or incapacitated.  We smoke, abuse alcohol and drugs, carry guns, drive fast, forget seatbelts, neglect immunizations, shun prenatal care and spread sexually transmitted diseases. We ignore social problems until they create health care consequences—low birth-weight babies, elderly who lack social acceptability, and teens suffering gun-shot wounds. When these risky behaviors result in chronic or high-cost illnesses and disabilities, health-care providers are expected to assure that we get the care we need, insulating us from the cost of our choices by providing whatever we need within a fixed budget. The time has come to broaden all of our health policy and political discussions to encompass the realities that, with rights come responsibilities.

So some questions:

• If managed care has a responsibility to meet all the patients’ needs, do patients have the responsibility to practice healthy lifestyles?
• If patients have the right to sue health-care providers for the failures to meet the patient’s expectations, do health-care providers have a similar right—to sue patients for the costs incurred from their failures to follow medical advice?
• At what point do patients who have rights also become citizens who have responsibilities, particularly as we all—collectively—pay for each other’s health care?
• If the community has a right to call on health-care providers to keep us all productively at work and at school, do communities have a responsibility to do their share as well?
• As the population ages and more health-care costs are attributable to lifestyle, can we afford not to hold patients and communities more responsible for their own health-damaging, cost-increasing behaviors?

What will it take?  Will clinicians, payers and managed care groups be forced to sue patients and communities to get the debates going?

Consider hypertension.

 Health-care providers collectively are asked to:   

• identify patients at-risk from population-based studies,
• call them in for examinations and diagnosis,
• counsel them about diet, exercise, smoking cessation and lifestyle modification,
• prescribe the right medications
• stay current on latest treatment interventions,
• subsidize the cost of those medications,
• place patients in compliance programs to be sure they are taking the medications,
• follow-up to assure the medications are working,
• adjust those medications if they are not as effective as hoped.

 The patient, on the other hand, need do nothing. The patient need not

• stop smoking,
• eat right,
• exercise or
• adhere to the prescription’s directions.

Further, the community need not be supportive, either. Communities need not 

• assure that streets are safe so that people can exercise near their homes,
• that children have healthy food in schools,
• that public policies support healthy lifestyles or
• that those who need help paying for treatments receive that help.

 Yet, years later, if the patient has a heart attack or stroke, the healer must arrive at the emergency room, provide intensive care and help with rehabilitation, all within a negotiated capitated-care rate.

This entry was posted on Monday, July 6th, 2009 at 2:43 pm and is filed under Access, Consumer Health Care, Coverage Policy, Health Reform, Insurance, Patients, Patients' Rights, Policy, Politics, Quality. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.