The Captain
Junior Associate
Hugs are good...
Joined: Jan 4, 2011 16:21:23 GMT -5
Posts: 8,717
Location: State of confusion
Favorite Drink: Whinnnne
|
Post by The Captain on Jan 8, 2014 13:39:18 GMT -5
The Jahi McMath thread as well as some other events got me to wondering...
Does anyone know how countries with single payer healthcare systems handle cases where the patient goes against medical advice?
I'm not talking about the "you need to drop 5lbs", but seriously ignoring doctor's orders and causing significant costs as a result.
Obviously we also have the problem in the US. However I personally know of two cases where the individuals impacted have refused medical advice and have racked big bills as a result. Since they don't have to pay out of their own pocket there is NO incentive (um, maybe than being a bit healthier?) for them to listen to the doctor.
So, just wondering if any other country has a potential solution to this issue.
|
|
|
Post by The Walk of the Penguin Mich on Jan 8, 2014 13:50:51 GMT -5
I did.
When I got infected, I refused to allow surgery to take out the joint. As the system we were in was self insured, but administered by a health plan, it would have been waaaay cheaper for me to have surgery there.
Instead, I left the hospital against medical advice with a picc line and a drain, to get on a plane and fly across the country where I was sure that I could get much better medical care.
9 days in the hospital there cost $25k vs the $108k bill the insurance company got for a 7 day stay (plus surgery).
It would have cost my insurance company less, but there is no doubt in my brain that I would have wound up permanently in a wheelchair had I let them cut on me.
|
|
tloonya
Junior Associate
What status?
Joined: Dec 18, 2010 16:22:13 GMT -5
Posts: 8,452
|
Post by tloonya on Jan 8, 2014 14:05:02 GMT -5
My! mother! after massive heart attack had decided that she is feeling good enough and she doesn't need any pills anymore, so she stopped taking them for at least 6 month. Until she told me and I yelled at her and put her back on, she was saying 'its just an expensive chalk'
|
|
kittensaver
Junior Associate
We cannot do great things. We can only do small things with great love. - Mother Teresa
Joined: Nov 22, 2011 16:16:36 GMT -5
Posts: 7,983
|
Post by kittensaver on Jan 8, 2014 14:12:30 GMT -5
I go against medical advice every.single.time I walk into my conventional doctor's office and they want to shoot me up with vaccines, radiate me with mammograms, etc. No thank you. I'll take full responsibility for any outcomes for my decision. I believe I will live a longer and healthier life by not being bombarded with unnecessary "just in case" chemicals and radiation, especially when I have no active diseases.
Flame Away.
|
|
The Captain
Junior Associate
Hugs are good...
Joined: Jan 4, 2011 16:21:23 GMT -5
Posts: 8,717
Location: State of confusion
Favorite Drink: Whinnnne
|
Post by The Captain on Jan 8, 2014 14:13:56 GMT -5
The Walk of the Penguin Mich - I see you point but that's not the instance I'm contemplating. You chose to follow medical advice at a different facility. One guy I know has type II diabeties, has been told he really needs to drop some weight and get his blood sugar under control. He's refused to do anything except take the medicine the doctor gives him which does nothing if he keeps drinking alcohol and eating a buch of processed foods. He has several sores that won't heal and was hospitalized a few times for MRSA infections. He also has partial kidney failure and will likely need to go on dialysis at some point. Yet he won't give up the drink, eat healthier, or even try to excercise. I think in some ways he's passively committing suicide.
|
|
midjd
Administrator
Your Money Admin
Joined: Dec 18, 2010 14:09:23 GMT -5
Posts: 17,720
|
Post by midjd on Jan 8, 2014 15:04:45 GMT -5
Last summer, my dad (who is on heparin for blood clots) had some pain in his leg and thought it might be a clot - but rather than go to the doctor, he decided to take a double dose of blood thinner.
He ended up with severe internal bleeding and almost died. After 2 days in ICU he checked himself out AMA because his hospital roommate was (possibly) HIV+.
He is insane.
|
|
haapai
Junior Associate
Character
Joined: Dec 20, 2010 20:40:06 GMT -5
Posts: 5,983
|
Post by haapai on Jan 8, 2014 16:32:04 GMT -5
I'm not sure that making the patient pay at least a portion of their medical care makes them more likely to follow medical advice that will minimize their future medical costs.
I'll be paying $100 a month in tobacco surcharges and lost wellness incentives this year so it obviously hasn't had much effect on me.
I don't think that the loss of the threat of future out-of-pocket medical expenses is much of an argument against single-payer health care systems.
Did I understand the question correctly?
|
|
Deleted
Joined: Oct 8, 2024 9:13:08 GMT -5
Posts: 0
|
Post by Deleted on Jan 8, 2014 16:32:20 GMT -5
I know that with dialysis, if you do not stay somewhat compliant they can take you off of the treatments.
|
|
The Captain
Junior Associate
Hugs are good...
Joined: Jan 4, 2011 16:21:23 GMT -5
Posts: 8,717
Location: State of confusion
Favorite Drink: Whinnnne
|
Post by The Captain on Jan 8, 2014 17:12:57 GMT -5
I'm not sure that making the patient pay at least a portion of their medical care makes them more likely to follow medical advice that will minimize their future medical costs. I'll be paying $100 a month in tobacco surcharges and lost wellness incentives this year so it obviously hasn't had much effect on me. I don't think that the loss of the threat of future out-of-pocket medical expenses is much of an argument against single-payer health care systems. Did I understand the question correctly? Note quite, I'm trying to figure out if countries where healthcare is truly covered by "society" if it is allowed for individuals to make decisions the cost "society" tens if not hundreds of thousands of dollars which could be avoided. I feel like I'm still not asking the question correctly.
|
|
justme
Senior Associate
Joined: Feb 10, 2012 13:12:47 GMT -5
Posts: 14,618
|
Post by justme on Jan 8, 2014 17:21:07 GMT -5
I'm not sure that making the patient pay at least a portion of their medical care makes them more likely to follow medical advice that will minimize their future medical costs. I'll be paying $100 a month in tobacco surcharges and lost wellness incentives this year so it obviously hasn't had much effect on me. I don't think that the loss of the threat of future out-of-pocket medical expenses is much of an argument against single-payer health care systems. Did I understand the question correctly? Note quite, I'm trying to figure out if countries where healthcare is truly covered by "society" if it is allowed for individuals to make decisions the cost "society" tens if not hundreds of thousands of dollars which could be avoided. I feel like I'm still not asking the question correctly. So are you basically asking if people are allowed to check out of the hospital or forgo a medical test/treatment AMA or are they required to do what the doctors recommend?
|
|
mmhmm
Administrator
It's a great pity the right of free speech isn't based on the obligation to say something sensible.
Joined: Dec 25, 2010 18:13:34 GMT -5
Posts: 31,770
Today's Mood: Saddened by Events
Location: Memory Lane
Favorite Drink: Water
|
Post by mmhmm on Jan 8, 2014 17:21:17 GMT -5
This article may provide you with some of what you're seeking, Captain: link
|
|
wvugurl26
Distinguished Associate
Joined: Dec 19, 2010 15:25:30 GMT -5
Posts: 21,883
|
Post by wvugurl26 on Jan 8, 2014 17:27:02 GMT -5
I don't see how you force someone to do something. On the flip side they don't listen to medical advice and develop a bigger, more costly problem down the road, I think refusing to treat them would be contrary to medical ethics. If they are an adult and don't want treatment down the road, I'm okay with them refusing treatment.
|
|
haapai
Junior Associate
Character
Joined: Dec 20, 2010 20:40:06 GMT -5
Posts: 5,983
|
Post by haapai on Jan 8, 2014 17:29:20 GMT -5
Maybe we'll get farther if we separate the costly AMA decisions into two piles.
In the first pile you have the decisions to continue down an unhealthy path that are made by the patient despite copious medical advice to the contrary.
The second pile is for all those cases where the patient (or the patient's family) wants care that medical professionals have deemed unwarrented, inappropriate, unlikely to succeed despite tremendous cost, or unlikely to improve the quality of life.
Which pile are you talking about?
|
|
Phoenix84
Senior Associate
Joined: Feb 17, 2011 21:42:35 GMT -5
Posts: 10,056
|
Post by Phoenix84 on Jan 8, 2014 17:31:54 GMT -5
I'm not sure. But the right to refuse treatment is part of the patient's bill of rights. I don't see a way around that. Do you suggest forcing people to get treatment that they don't want?
|
|
The Captain
Junior Associate
Hugs are good...
Joined: Jan 4, 2011 16:21:23 GMT -5
Posts: 8,717
Location: State of confusion
Favorite Drink: Whinnnne
|
Post by The Captain on Jan 8, 2014 17:33:50 GMT -5
No, haapai clarified it much better than I could. Both. The thread about the brain dead girl got me thinking about the second scenario you mentioned, but the two personal situations I know of also touch on the first.
|
|
Opti
Community Leader
Joined: Dec 18, 2010 10:45:38 GMT -5
Posts: 42,243
Location: New Jersey
Mini-Profile Name Color: c28523
Mini-Profile Text Color: 990033
|
Post by Opti on Jan 8, 2014 17:36:24 GMT -5
I haven't checked out Mmhmm's link but we already make it hard to go against medical advice in various instances. The guy in Texas can't remove his wife off machines because of a law there and I believe there are certain things you get treated for whether you want to be or not like heart attacks, mental issues that someone deems you a harm to others or yourself just to name a couple.
I'm not entirely sure what you are trying to ask but I think people are people and they are going to go against advice medical or not because sometimes it is wise to do so and sometimes they don't care that the advice would help them. I don't want a world where we lose freedom of choice. With the Texas law and some others its already out of control in my opinion without having single payer or government healthcare. Sometimes you know medical advice is wrong for you and the wise course is to stick to your path if you can. Sometimes like today you see people reappear back at the subactute facility within a day to a week of discharge because they didn't want to believe they weren't ready to be on their own.
|
|
Opti
Community Leader
Joined: Dec 18, 2010 10:45:38 GMT -5
Posts: 42,243
Location: New Jersey
Mini-Profile Name Color: c28523
Mini-Profile Text Color: 990033
|
Post by Opti on Jan 8, 2014 17:40:38 GMT -5
I think there's at least another pile like Mich alluded to.
The pile where medical advice says you should do X and you are pretty sure X is going to have long term consequences you don't like so you choose Z. There are medications for example that work well on most people, but you may know due to your own physical makeup it is likely to harm instead of help you.
|
|
The Captain
Junior Associate
Hugs are good...
Joined: Jan 4, 2011 16:21:23 GMT -5
Posts: 8,717
Location: State of confusion
Favorite Drink: Whinnnne
|
Post by The Captain on Jan 8, 2014 17:42:18 GMT -5
I don't think any once can "force" someone to accept treatment (although there are rare cases such as MDR-TB) I am trying to figure out in countries with socialized medicine if they have addressed the issue of how to deal with non-compliance. Do they continue to treat the patient even though the patient refuses to take steps to reduce the overall cost of treatment? Or honestly, at some point do they tell the patient you refuse to cooperate so you no longer are entitled to healthcare? Still not really wording it well.
|
|
|
Post by The Walk of the Penguin Mich on Jan 8, 2014 17:54:00 GMT -5
I don't see how you force someone to do something. On the flip side they don't listen to medical advice and develop a bigger, more costly problem down the road, I think refusing to treat them would be contrary to medical ethics. If they are an adult and don't want treatment down the road, I'm okay with them refusing treatment. The problem you run into is if you disagree with treatment. When I walked out of the hospital AMA, I was informed by the nurse that the insurance company was not going to cover those 9 days, unless I complied with surgery. Only problem was that I had successfully avoided this surgeon for 8 years, he had less than great results, was not known for keeping up with advances, and the hospital had an abysmal record of post surgical infection. So because I walked out, refusing THEIR treatment, I should have been refused subsequent treatment? The 24 hours that I was without antibiotics probably worsened my condition, causing the septecemia and lung infection as well. BTW....my insurance paid the hospital bill.
|
|
Bonny
Junior Associate
Joined: Nov 17, 2013 10:54:37 GMT -5
Posts: 7,459
Location: No Place Like Home!
|
Post by Bonny on Jan 8, 2014 18:03:34 GMT -5
|
|
The Captain
Junior Associate
Hugs are good...
Joined: Jan 4, 2011 16:21:23 GMT -5
Posts: 8,717
Location: State of confusion
Favorite Drink: Whinnnne
|
Post by The Captain on Jan 8, 2014 18:04:29 GMT -5
The Walk of the Penguin Mich - actually you raise another good question I've been wanting to ask. In countries with single payer systems do patients have the right to see the doctor they choose, or is one chosen for them? I wish some of our friends from the UK and Canada would chime in.
|
|
|
Post by The Walk of the Penguin Mich on Jan 8, 2014 18:06:15 GMT -5
It is not easy to go against medical advice. Not only did I balk at surgery, I refused to let them aspirate my hip. I had the whole orthopedic department pissed at me, and they harassed me for a good week.
The problem was that where the abscess was located, if my hip was not infected, aspirating the hip would seed the prosthesis and infect it. The only person who agreed with me was the radiologist, who KNEW he was going to run the risk of seeding my prosthesis if he stuck a needle in me. It wasn't until he offered to do other imaging, and if that imaging didn't show anything, HE was going to tell the orthopod that HE was the one refusing to do the aspiration. I agreed to this.
However, the entire time I was there, I had to deal with the relentless bulldozing. As I had no family in the area, no one ran interference. Favorite attempts to bulldoze were 5 am, or after midnight. I think that they withheld pain meds to try to get me to comply.
Bucking the system is not as easy as you seem to think.
|
|
haapai
Junior Associate
Character
Joined: Dec 20, 2010 20:40:06 GMT -5
Posts: 5,983
|
Post by haapai on Jan 8, 2014 18:10:29 GMT -5
FWIW, refusing to treat a non-compliant patient is pretty common in our own system. Sometimes it is overt, i.e. there is a procedure for firing a non-compliant patient but it is more commonly buried in the standards of care.
Alcohol is usually involved.
|
|
milee
Senior Associate
Joined: Jan 17, 2012 13:20:00 GMT -5
Posts: 12,344
|
Post by milee on Jan 8, 2014 18:12:41 GMT -5
The Walk of the Penguin Mich - actually you raise another good question I've been wanting to ask. In countries with single payer systems do patients have the right to see the doctor they choose, or is one chosen for them? I wish some of our friends from the UK and Canada would chime in. In the UK, you do not have the right to choose your own doctor, except in some limited cases and your preference is not the primary concern. You also are on very long wait lists for non-life threatening surgery. Oh, and their cancer survival rates are much lower than in the US, because cancer treatment is not given the same priority it is here.
|
|
|
Post by The Walk of the Penguin Mich on Jan 8, 2014 18:12:48 GMT -5
The Walk of the Penguin Mich - actually you raise another good question I've been wanting to ask. In countries with single payer systems do patients have the right to see the doctor they choose, or is one chosen for them? I wish some of our friends from the UK and Canada would chime in. Depends. You need to get your GP to comply with your request. I have a friend in Canada who went through hip hell. It was so bad that for a period of about 5 years, she came to the US and paid OOP for treatment. It took her awhile to convince her GP to send her to one orthopod that she heard was good with revisions. But rather than her calling, she had to wait for her GP's office to arrange it. I want to say that took about 6 months. It took another 3 months to get an appointment. When he said he could help her, it took another 9 months to get her onto the surgical schedule....and she got about 3 weeks notice of her surgery date.
|
|
The Captain
Junior Associate
Hugs are good...
Joined: Jan 4, 2011 16:21:23 GMT -5
Posts: 8,717
Location: State of confusion
Favorite Drink: Whinnnne
|
Post by The Captain on Jan 8, 2014 18:16:59 GMT -5
You're right, but in the meantime the family dragged it out 3-4 weeks. Average daily cost in ICU is in excess of $4K per day. If the family continued to drag it out in court it could easily have topped out at over $100k to keep a dead body warm because someone refused to accept medical guidance. I'm just wondering how similiar cases are handled in countries with socialized systems. Does the individual/family have the final say in how much is committed in resources or does the government?
|
|
HoneyBBQ
Junior Associate
Joined: Dec 27, 2010 10:36:09 GMT -5
Posts: 5,395
Mini-Profile Background: {"image":"","color":"3b444e"}
|
Post by HoneyBBQ on Jan 8, 2014 18:27:01 GMT -5
I go against medical advice every.single.time I walk into my conventional doctor's office and they want to shoot me up with vaccines, radiate me with mammograms, etc. No thank you. I'll take full responsibility for any outcomes for my decision. I believe I will live a longer and healthier life by not being bombarded with unnecessary "just in case" chemicals and radiation, especially when I have no active diseases. Flame Away. YMMV, but how do you know you don't have microscopic breast cancer? I'm glad the recommended screening period is longer than it used to be, but it's still an important step in the process. An interesting read if you're open to it: www.nytimes.com/2013/11/12/business/media/abc-anchor-says-test-on-show-found-breast-cancer.html?_r=0This news anchor delayed her mammogram... found out she had breast cancer when a fellow anchor talked her into doing a live mammogram on air.
|
|
haapai
Junior Associate
Character
Joined: Dec 20, 2010 20:40:06 GMT -5
Posts: 5,983
|
Post by haapai on Jan 8, 2014 18:30:43 GMT -5
Isn't it better for the government to make that decision instead of an insurance company?
|
|
kittensaver
Junior Associate
We cannot do great things. We can only do small things with great love. - Mother Teresa
Joined: Nov 22, 2011 16:16:36 GMT -5
Posts: 7,983
|
Post by kittensaver on Jan 8, 2014 18:32:29 GMT -5
I go against medical advice every.single.time I walk into my conventional doctor's office and they want to shoot me up with vaccines, radiate me with mammograms, etc. No thank you. I'll take full responsibility for any outcomes for my decision. I believe I will live a longer and healthier life by not being bombarded with unnecessary "just in case" chemicals and radiation, especially when I have no active diseases. Flame Away. YMMV, but how do you know you don't have microscopic breast cancer? I'm glad the recommended screening period is longer than it used to be, but it's still an important step in the process. An interesting read if you're open to it: www.nytimes.com/2013/11/12/business/media/abc-anchor-says-test-on-show-found-breast-cancer.html?_r=0This news anchor delayed her mammogram... found out she had breast cancer. I go for an annual breast thermography exam. If administered and read by competent people, it can detect breast cancer UP TO TEN YEARS sooner than a mammogram. By the time a mammogram can "see" cancer/a tumor (after all, it's only an x-ray) you are already in trouble. And you've been doused with years of radiation. No thanks. Thermography is non-invasive and non-radioactive. When administered correctly, it has lower false-positive and false-negative readings than mammography. Too bad "the system" is so caught up in paying for its fancy breast machines that it won't see past the end of its nose to look at other methods. Flame Away.
|
|
HoneyBBQ
Junior Associate
Joined: Dec 27, 2010 10:36:09 GMT -5
Posts: 5,395
Mini-Profile Background: {"image":"","color":"3b444e"}
|
Post by HoneyBBQ on Jan 8, 2014 18:35:18 GMT -5
I submit go for an annual breast thermography exam. If administered and read by competent people, it can detect breast cancer UP TO TEN YEARS sooner than a mammogram. By the time a mammogram can "see" cancer/a tumor (after all, it's only an x-ray) you are already in trouble. And you've been doused with years of radiation. No thanks. Thermography is non-invasive and non-radioactive. Too bad "the system" is so caught up in paying for its fancy breast machines that it won't see past the end of its nose to look at other methods. Flame Away. I don't think I flamed your first post, nor this one. Actually, MRI is one of the best methods to detect DCIS, and other small breast cancers. However, it's ridiculously expensive and not practical for routine care for 50% of the population. Also, there just aren't enough themography centers to do that sort of work... I'm surprised your insurance would pay for that (if it did?). We (as a society) have to balance the appropriate test for the appropriate number of people. Healthcare is already going bankrupt with mammograms, let alone implementing more labor intensive tests to half the people in the country.
|
|