Little town of McAllen, Texas is now famous for being the second most expensive Healthcare town with the least household income. Medicare paying $15,000 per enrollee in 2006 and average income being 12,000 per capita. But even this doesn’t buy the best quality of care, the town suffers from full spectrum of chronic diseases that the whole country is struggling with. This was reported in a well written article in The New Yorker by Atul Gawande.

This article has become a ‘must read’ in the White House, reports The New York Times, as the President summoned his aides to discuss the little town in Texas. It is great to witness the sensitivity of Washington and the political will to fix the current overwhelming healthcare system.

I am writing this blog as a physician who is concerned about the Healthcare order in the country and would like to participate in the Healthcare reform. I have been working actively to innovate a simple solution that addresses a big part of the puzzle, mainly the healthcare cost. After many years of research and experience of being the first face of medicine, aka Primary Care Provider, I have come to the conclusion that there are 3 main reasons of rising the healthcare cost:

1. Lack of an open healthcare market- because of third party payer or Insurance industry, ‘the patient’ doesn’t know or doesn’t care about the price of the test, hence doesn’t question the need and the cost of the test. This leads to over utilization of tests and treatments, complications and disparity of costs of same tests/treatments.
2. Poor care in the End of Life - over utilization of expensive medical tests and treatments for patients who only want to pass away respectfully at home. Data shows 95% patients want to die at home but 75% of patients die in healthcare institutions.
3. Unnecessary Medical law suits- leading to defensive medical practice that causes unnecessary testing and treatments and also leads to rising overheads for the physicians.

HealDeal addresses the first problem by removing the middleman - i.e. insurance industry. This online platform connects the patient directly to the Doctor to get a price information for a medical service, this helps the patient to manage and stretch their healthcare dollars, and that forces the cost disparity to resolve and fair market competition to happen. This way the doctor also participates in improving access to healthcare for the uninsured patients.

Archana Dubey, MD

In the last one week we have all witnessed the challenge of H1N1 flu, formerly known as ‘Swine Flu’, impacting multiple countries. Our health care preparedness was tested and our biggest vulnerability was identified to be uninsurance as quoted by Associated Press article.

“To have an epidemic with millions of people who may not go to the doctor because they can’t afford to pay remains one of the unique challenges of our system.” said Dr. Georges Benjamin, executive director of the American Public Health Association, “The person I’m most worried about is the one who decides to delay getting care, and does it in such a way that they infect others or put themselves at greater risk.”

Public health experts say obstacles to getting medical attention are counterproductive if you’re trying to stop an infectious disease in a highly mobile society like the United States. It is especially a challenge when one in seven people lack health coverage, who delays treatment or utilizes crowded Emergency Rooms, hence making the epidemic worse.

HealDeal is a solution that improves access to doctor care early in the process, helping patients to get tested early and treated in a timely manner.

Archana Dubey, MD

Yet another patient of mine lost his job and both husband and wife in their mid 60’s lost their health insurance. Husband struggling with advanced liver disease and the wife with Diabetes and High Blood Pressure, left to sort out their medical expenses. They started skipping their pills every other day so they can ’stretch it’ longer. The cost of the medicines and the blood work for their chronic diseases prohibited them to care for their health appropriately……. and this is just one of my many patients who have lost their insurance.

The health care cost is taking a toll on our health and wellbeing.

More than half (53%) of the American households cut back on their health care secondary to cost concern, reports Kaiser Family Foundation survey of February 2009.

One in four put off the health care they needed, 16% delayed care for a serious medical illness.

One in five didn’t fill prescriptions.

One in six skipped their medications to make it last longer.

One in five experienced serious financial hardships secondary to their health care expenses. 12% have been reported to collection agency.

HealDeal is envisioned to bring transparency and fair market practices to health care. Patients who are self pay will be able to manage their health care dollars effectively. As Mr. Dave Mandelkern, CEO of QuickHealth, says ‘One of the myths of the self pay market is that the consumer is not savvy enough, its just that they don’t have the tools to manage their health care expenses’. Here at HealDeal we work hard to bring these tools to our self pay consumers.

Archana Dubey, MD

This is a call for all the consumers of Healthcare aka. patients, please get to know the mandatory ‘Universal’ Healthcare solution, either you will be within network or without one.

Dear Consumers of Healthcare:

1. If you thought ‘Universal Healthcare’ increases our access to heathcare then be ready for unpleasant surprises.

There is a difference between universal coverage and actual access to medical care. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain’s Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that “access to a waiting list is not access to healthcare.”

The solution of mandatory purchase of health care products from private for profit insurance companies is a simply unjust. Those who can only afford the minimal plans will remain largely exposed. The premiums are still too high and can cause real economic hardship for those who do not qualify for subsidization. The program increased the number who qualify for subsidization but had no provision to fund them. The cost of that legislative blunder is already being passed on to those who can least afford it in the form of more penalties in 2008, a discriminatory and possibly illegal act that essentially raises the income tax rate for a targeted population.

2. If you thought insurance improves the quality of healthcare then think again.

The New England Journal of Medicine study in 2006 found that- “health insurance status was largely unrelated to the quality of care.”

The Access Project, based in Boston, released the findings of its recent independent study of the health insurance industry- “The Illusion of Coverage.” The report demonstrates the specific ways in which health insurance products deliberately fail to protect people financially and fail to guarantee their access to needed care.

Our dangerous obsession with universal coverage will lead us to neglect important consumer reforms, such as enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets — that could truly expand coverage, improve quality and make care more affordable.

Healthcare isn’t really a priviledge or a right, it is actually a choice.

Archana Dubey, MD

New study finds-cancer diagnosis linked to insurance….

People who are uninsured or on Medicaid were more likely to be diagnosed with cancer in later stages. This includes common cancers that can be screened early like prostate, cervical and breast cancer.

This study further validates the negative impact of uninsurance, that has become a disease worse than even cancer. It also validates the negative impact of insurance- private or government.

The application of insurance in US Healthcare is very unlike in any other industry. In any other industry, consumers take control of their routine expenses and insurance is utilized for catastrophic needs. In Healthcare, consumers have come to expect utilization of insurance for routine care also, this has made us depend largely on insurance to prevent illness. When we land up with uninsurance, we do not take control of our health and lag in preventitive care and results are evident from the study.

This calls for shift in market, from the monopoly of insurance (private or state sponsered like Universal healthcare) to a free market. This shift will also enable us to address the huge problem of rising cost of Healthcare and will support quality Healthcare.

Shifting paradigm from “you manage my care” to “I manage my care”.

Working on it,

Archana Dubey, MD

Back from my Mind Body Medicine conference at New Orleans where we were also working with people who survived Katrina and working to rebuild the ’soul’ city.

I need to congratulate Dr. Jim Gordon who founded the Center of Mind Body Medicine. He and his faculty have been working in troubled areas of the world like Gaza, Kosovo and now New Orleans.
We all learned various techniques of self care and self healing so we could teach our patients. It sounds like a great idea as a concept.

My first day back at the HMO (Health ‘Maintenance’ Organizations) ridden practice. Mind and Body was confused by suboptimal time available with each patient and mentioning the relaxation breathing further confused my patients causing more questions and longer delays in seeing the next patient. Rough landing to the real world…

Later in the week I wondered about all those great studies supporting these Mind Body techniques, why are those not mentioned in CNN or advertised with Lipitor, Viagra or Lunesta. Why is our healthcare delivery is focused on disease management and ignoring the Health Maintenance?

It is about time the consumers of healthcare industry start investing their time in self-care and take control of prevention of disease and partake in medical decision making. Health 2.0 revolution can work towards consumer empowerment.

To the mind and body….breathe soft belly….

Archana Dubey, MD

Just to validate the prior posting….

Facts:

According to a US census report published in August 2007, we have increased our household income, but declined our healthcare coverage in the last year (from 44.8m (15.3%) to 47m (15.8%)of uninsured). This decline specially affected the children (approximately 10% decline in insurance coverage) and the families that have a household income of more than 75,000, who are not eligible for government benefits because they are not poor enough!

The response from the political leaders, both Republicans and Democrats, have been prompt, but they all have suggested solutions built on the current system and infrastructure.

Opinion:

Trying to find solution that is built on the already ailing healthcare industry is setting ourself for a failure and collapse of the biggest industry in the United States. We have to think outside the box and support innovative ideas to bring a radical change ground-up. Consumers and providers need to collaborate in the decision making process.

from the healthcare think tank…this is Archana Dubey, MD

As healthcare consumers – a.k.a. patients, we wonder, who is sicker, we or the Healthcare system that is treating us…or is it treating us right?

From the best MBA schools to the movie ‘SICKO’ , from the election campaign to the not-for-profits, like ‘Cover the uninsured’, the question remains…. 

In a recent survey by Kaiser Family Foundation, Healthcare is the top domestic issue in the 2008 elections, trailing just after Iraq war in all issues.  Here are some dollars and nonsense: 

• Our health care expenses are $1.9 trillion (2004), 16% of GDP, about 4% more than what we spend on defense. 
• Consumers are paying higher premiums, higher co-pay, higher deductibles and higher co-insurance and getting lesser coverage in the last decade, per a study done by Kaiser family foundation. 
• Uninsured in the US increased to a staggering 46million and increasing. 

Market is longing for a change…according to ABC News/Kaiser Family Foundation/USA Today Health Care in America 2006 Survey: 

• Despite the amount of healthcare expenses, Americans are dissatisfied with the cost and quality of our health care. 
• Consumers want to see and use health care quality information to make health care decisions. 

Consumers are hurting and market is ready….it’s about time to free the fair market and empower the patient who is not so patient anymore…. 
Happy Labor Day! 
Archana Dubey, M.D.