Polity: Land of the brave little kids
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Rosemary McDonald, in reply to
got medical insurance in the 70s when they discovered they had no hope a getting a routine operation in the public system
Ditto for an old friend, an ardent National supporter. However when she was sent to the Public Hospital for an assessment on a painful gallbladder issue, she took umbrage at the surgeon asking her if she had medical insurance. This was, after all the Public System...talk of medical insurance had no place there. She radically changed her diet to relieve the symptoms and staunched it out until she floated to the top of the list.
Move on to the late 80s when she developed cataracts, she opted to use her insurance as her ability to drive was threatened. Her premiums had been going up throughout this time of course. Claim went in. Claim was instantly declined. Enter stroppier friend who went with her to the insurers office and collectively stood our ground...."pre-existing condition? Hah!"
A few years later a fellow nurse aide was saying how she worked for that insurer at that time. The Boss had instructed staff to routinely decline at least 50% of claims on a random basis...presumably some law of averages dictated that a worthwhile ( in terms of profit) percentage of declined claims would not be challenged.
My colleague questioned this policy, and processed each claim on its merits. The Boss took her quietly to one side and paid her to leave. She was much happier in her much lower paid but more morally comfortable job caring for sick elderly people.
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Angela Hart, in reply to
Thanks Sacha, that is a tremendous presentation by Ron Paterson and resonated with me on many levels. I met Judi, although I didn't know her well. I knew of her illness and that she continued to work in spite of it until it simply wasn't possible any more.
The issues she recorded and Ron mentions are all familiar, though ours are more to do with Doctors not engaging with each other than with scheduling.
I'll share one story that echoes Judi's experience of not being properly informed. My daughter was diagnosed with an arrhythmia. We went to a hospital appointment expecting to meet the consultant and be given some treatment options. Instead my daughter was prepped as if for surgery. We said hang on a minute what is this about? A registrar explained that she was down for cardioversion.
What? She hasn't even met the consultant. What is this, what are the risks - oh, we stop your heart and when it restarts it's usually in a normal rhythm, arrhythmia gone. We find out later that if cardioversion works the sinus rhythm may only last up to 6 months. My daughter was terrified. What if her heart decided not to start up again?
Because we said hang on a minute, we don't know anything about this and asked a lot of questions. Because there were two of us, it wasn't just the patient and because my daughter is who she is, she decided not to let them do this, at least not at that time. But informed consent? Informed consent expects a person to have a reasonable amount of time to consider, to have all the pertinent information and to be in a mental state which allows clear thinking (there was another more egregious abuse of the consent process later in our journey which took advantage of semi-consciousness to get "informed consent").To be fair- the consultant made a professional judgement about the best and most likely to be effective course of action and set it in motion. Cardioversion has the best chance of working when it is used soon after an arrhythmia starts. It was just that he didn't manage to tell the patient prior and wasn't able to be there for the procedure either.
I haven't met Ron but he is my hero. He investigated the Ministry of Health's assertion to me that NASCs are not subject to the OIA and corrected their misconception.
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Anecdotal evidence from my involvement in facebook and other groups suggests that children is the US with global development delays get very good access to early intervention therapies. Sometimes daily speech, physical and occupation therapy visits.
This can be compared to the NZ system which promises a lot but the visits can be fairly infrequent and in the case of speech therapy, almost non-existent, due to a lack of resources (ie money, hence less therapists to go around). The emphasis instead seems to be on teaching the parents how to provide therapy to their own kids.
As stated, this is only my experience my own child and learning from other parents with special needs kids.
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Rosemary McDonald, in reply to
and corrected their misconception.
Were explosives involved?
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Angela Hart, in reply to
:-) not even expletives as far as I know. It remains to be seen whether the quality of information available to the public will improve.
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Tinakori, in reply to
Never had that problem with Southern Cross, including for oral surgery that could just as easily be done by a dentist.
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Rob Salmond, in reply to
How often, I wonder, are the outcomes for the child proportional to the Bolshie levels of the parent?
Sadly, quite a lot I think, and that means kids fortunate enough to have well-educated parents with flexible jobs have better outcomes. When the system relies on parents to advocate or make decisions, higher SES families are advantaged. I'm not sure there's any way fully around that, but health systems can work hard to provide advocacy support for parents and families where needed.
Here's what I wrote, in terms of advice, to other parents with complex kids:
Our health insurance provider denied us coverage several times for major aspects of Sophie’s treatment, including her 2V surgery in Boston, both medical flights, and various parts of her feeding kit. We got them to change their mind every time. We read the rules, interpreted the rules in our favor when we could, and were persistent. You may not be able to turn your insurance around every time, but with complex children it is always worth one or even two tries when they say no. If you feel you aren't up for that challenge while you are caring for your sick child, find a good friend or family member and make them your insurance advocate.
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Rob Salmond, in reply to
I read your story about your daughter Rob, and I teared up at work. I hope things are easier for you now.
Than you Stephen, for a really nice comment. Of course, the pain of losing a child never disappears, and no parent ever "gets over it." Put Sophie's struggle is more in the background of my life than it was, replaced in the foreground with other challenges and opportunities, wins and losses.
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Certianly my post wasn't intended to defend the insurance-based provision of healthcare, prevalent in the US. I think it has a lot of downsides, and the single-payer model we have in New Zealand is better. The bureaucracy, contents attempts to cut corners and deny coverage, and constant ripping off of insurance companies by doctor and hospitals, are all stains on US healthcare, not to mention the other issues of the uninsured being forced to use ERs as GPs and so on.
I think the part of the US system that forges ahead - world-leading care of the most complex cases - would forge ahead whether they had health insurance of a single payer. The most important drivers of their excellence in that area are (1) population size, leading to specialisation; and (2) country-level affluence, leading to purchasing the best talent.
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Amy Gale, in reply to
The most important drivers of their excellence in that area are (1) population size, leading to specialisation; and (2) country-level affluence, leading to purchasing the best talent.
I think there is a third important driver, and it also applies to other areas (eg education): massive, massive inequality allows elite institutions to exist at one end of the spectrum, balanced by some truly terrible (or even nonexistent) provision at the other and weighted by a whole lot of quite-often-adequate-but... in the middle. The opportunities we get by going to the US for school or medical care or whatever all else are available because we are accessing the top end of this inequality spectrum. It's a profoundly uncomfortable realization, and so it should be.
I'm not sure that it's precisely the case that the situation wouldn't be different in a single payer system. It's more that its entrenchment acts against any transition to single payer being possible.
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Your you-tube video has been removed Sacha, perhaps it's a bit too challenging for the Misery.
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Rosemary McDonald, in reply to
Here's a MUCH more positive one from Ron...
(my you- tube history has no record of me watching the speech about Judi's awful experiences.)
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Or this....treasure...
http://www.hqsc.govt.nz/assets/General-PR-files-images/atul-gawande-forum/GR011-Ron-Paterson.pdf
wish I knew how to display image...
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A good report for Rehab from Ron, which we also have found to be patient centred although we did have to fight to get permission for me to stay and support my daughter- the focus being on independence so obviously you don't want family stepping in and doing stuff that the experts think the person could do for themselves. Thing is experts are generalists in terms of the categories they assign to patients, and that works for the majority of people who have similar, usually single, health issues. It doesn't work so well for high and complex needs, although again if there are enough to build and sustain a community of expert medical people as with SCI, it can work very well.
The key to making the system work is being listened to - not patronisingly but as an adult who knows your own or your loved ones condition well. This was part of what was lacking in Judi's care experience. -
Rosemary McDonald, in reply to
This was part of what was lacking in Judi’s care experience.
...and the part of Judi's account of her care experience that could possibly cause the most upset to those In Control, would be her use of IV High Dose Vitamin C.
And the obvious benefit to her(other than having to self fund the therapy).
And the research that proves that in those patients with the type of brain tumour Judi had...taking IV High Dose Vitamin C markedly improves the efficacy of the radiotherapy. And in general, patients undergoing cancer treatments who are also having High Dose Vitamin C therapy, side effects are fewer and quality of life significantly improved.
Yet the Miserly of Health still does not fund this therapy. (to my knowledge)
Why?
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Angela Hart, in reply to
The wheels turn but slowly, it is now clear that this vitamin C therapy does have a significant beneficial effect, such that money could be saved if this treatment was used to make the traditional treatment more effective. But this type of decision often seems to take an age for the health system to make. Cough assist machines are in a similar position- save hospital admissions but high initial outlay http://www.musculardystrophyuk.org/news/fighting-to-help-people-with-muscle-wasting-conditions-access-vital-cough-assist-machines/
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jb,
This is how it works in Germany: http://youmustbefromaway.com/2014/08/22/socialised-medice-in-germany/
Dental care's also included for basic stuff, co-payments for flash stuff
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