REBECCA S BUSCHHealthcare is a business, a BIG business. You need to know all the players are in this healthcare business – your doctor, your insurance company, your employer and the drug manufacturer. What is the goal of a business? To make a profit. That, my friends, is the cold reality of healthcare. An important thought to keep in mind when you visit your doctor.
The Healthcare Business
Let me illustrate my point with the following scenario. A biotechnology company, Dendreon, researched and developed a drug (Provenge) to treat advanced prostate cancer. Dendreon had big hopes for its new therapy. Investors had big hopes. The doctors, not so much. Why? Oncologists and urologists surveyed said two major factors in determining whether to recommend Provenge were the cost ($93,000) and the four month median of extra life. The bottom line for the majority was, “is the price worth the potential life extension?” Price versus life, not something we like to think about, but it is a reality. If it were up to the patient to foot the entire bill, price would definitely be a discussion point. I don’t want to come across as a cynic, but I can assure you insurance reimbursement is a deciding data point with the hospital/doctor as well.
Learn to Expect Healthcare Transparency
So, where does that leave the patient? What is the price point for extending a life? More importantly, who is making that decision? Currently, more than likely, it is a combination of the doctors and the insurance company. Let me be clear, I’m not slamming the doctors or the insurance companies, because as I said, it is a business, and cost is an issue. My point is ‘cost versus treatment’ isn’t for them to decide in a vacuum. We, the consumer, need to be part of the decision. In other words, we need to expect and ask for healthcare transparency.
In the scenario above, perhaps the doctor wouldn’t even bring up the option of Provenge based on reimbursement. That’s wrong. We need to be informed consumers. We need to ask “what treatments will my insurance cover and what are my options that aren’t covered?” Once you have this information, you can make a decision with your doctor.
Yes, healthcare is a business, your business. Make your healthcare your business.
Thanks for reading!
Healthcare Advocate
Rebecca Busch