Mrs. D’Angelo has been into the ER every 3 weeks for 6 months, complaining of painful gallstones. She is a Medicaid patient and does not present with the appropriate symptoms to make her eligible for immediate surgery.
This situation address one of the problems that low-income, Medicaid patients face when seeking medical care for non-life-threatening illnesses. Because Mrs. D’Angelo only exhibits 1 out of 3 blockage symptoms, gallstone removal is considered elective. Medicaid will not pay for the procedure and she will be put on an 18-month waiting list for surgery. After hearing this, Mrs. D’Angelo states that her neighbor had private insurance and got a removal the very next day. Lewis sends her home with a pain prescription.
Mrs. D’Angelo has been into the ER every 3 weeks for 6 months
- What are the pros and cons of waiting before surgically removing Mrs. D’Angelo’s gall bladder?
- Do privately insured patients get better treatment?
- In this case, how are you defining better treatment?
Sometimes, the “bottom line” can limit the type and amount of treatment a patient can receive. Many physicians realize that waiting for the situation to escalate might cause further costly problems for the Medicaid patient, but cannot provide the patient with the same level of care as a privately-insured patient. Considering the situation presented and the information learned from this class:
Mrs. D’Angelo has been into the ER every 3 weeks for 6 months
- Do you think that Medicaid should review their policy on whether this condition and similar ones like it should be classified as an elective surgery, that is, should Medicaid make such diagnosis/condition required or non-elective surgery?
- How would any change in this policy affect the cost of health care for that individual as well as all of us?
Private Insurance: The Key to Better Treatment
Pros and Cons of waiting before surgically removing the gall bladder
It makes a huge difference if Mrs. D’Angelo gets the right treatment at the right time. Since handling gallstone patients requires proper hospital care, waiting before surgically removing the gall bladder can provide Mrs. D’Angelo with ample time to save sufficient money to pay for the procedure. Moreover, as NRF (2014) states, immediate removal of the gall bladder can result in problems associated with anesthesia, infection and bleeding that can be avoided if Mrs. D’Angelo decides to wait before determining if surgery is necessary.
According to Cheruvu and Eyre-Brook (2002), delaying a needed gall bladder removal increases the surgical complication rate and may make Mrs. D’Angelo more likely to require open-abdomen surgery instead of a minimally invasive laparoscopic procedure. Moreover, if left untreated, the gall bladder problem experienced by Mrs. D’Angelo can turn into medical issues such as infection or inflammation of the gall bladder, pancreas or bile duct. Should the gallstones become lodged and block a duct, Mrs. D’Angelo can become jaundice.
Do privately insured patients get better treatment?Mrs. D’Angelo has been into the ER every 3 weeks for 6 months
Patient with private insurance get better treatment and hospital care than those without private insurance. This is evident in the fact that privately insured patients have lower mortality rates than patients who are not privately insured (Budryk, 2013). In addition, patients with private insurance have various treatment options at their disposal that are often not available to patients without private insurance and they also get better hospital care in terms of acquiring immediate treatment for illnesses, getting treatment in better medical facilities, as well as, access to sufficient medicine. Normally, privately insured patients do not have to be placed on a waiting list to undergo medical surgeries. They can schedule surgeries and other medical procedures at their most convenient time and consult with doctors with ease.
Better Treatment-Mrs. D’Angelo has been into the ER every 3 weeks for 6 months
Better treatment refers to the availability of adequate and comprehensive medication, therapy, surgery and other medical procedures and treatment methods to patients immediately for emergency cases and at convenient times to enable patients undergo treatment for less chronic medical conditions or illnesses.
Medicaid should review their policy on whether conditions such as the gallstones exhibited by Mrs. D’Angelo and other similar conditions should be classified as an elective surgery. In other words, Medicaid should make these conditions or diagnosis required or non-elective. As is the case of Mrs. D’Angelo, delaying a needed removal of the gall bladder for more than six days, may not only result in inflammation or infection of the gall bladder, pancreas or bile duct but also increase the rate of surgical complication and make the patient more likely to require open-abdomen surgery. Such complications normally end up being costlier for Medicaid to cover for the patient in terms of advanced surgery. Moreover, without the proper hospital care that is mostly available to privately insured patients, the suffering of the patient only worsens. Notwithstanding, this should only apply to cases whereby it has been medically determined that delaying treatment would most definitely result in chronic health complications and expensive treatment.
The cost of health care for patients and citizens in general will rise should Medicaid decide to alter its policy on conditions classified as an elective surgery with the aim of making them required or non-elective. This is because such diagnosis or conditions classified as elective surgery occur frequently among patients under Medicaid. It is for this reason that Medicaid chooses to render them as elective surgery so as to minimize the cost of health care whereby medical cover is only provides in situations whereby Medicaid dictates that the patient exhibits enough symptoms to warrant mandatory surgery. Since these conditions occur frequently among patients, recommending and authorizing immediate treatment for these conditions will result in an increase in the cost of health care that every citizen has to bear given that many people will be undergoing these immediate treatment procedures.Mrs. D’Angelo has been into the ER every 3 weeks for 6 months
Budryk, Z. (2013). Study: Privately insured patients receive better hospital care | FierceHealthcare. Fiercehealthcare.com. Retrieved 29 April 2018, from https://www.fiercehealthcare.com/healthcare/study-privately-insured-patients-receive-better-hospital-care
Cheruvu, C., & Eyre-Brook, I. (2002). Consequences of prolonged wait before gallbladder surgery. Annals Of The Royal College Of Surgeons Of England, 84(1), 20-22.
HRF. (2014). Pros and Cons of Gallbladder Removal – HRFnd. HRFnd. Retrieved 29 April 2018, from https://healthresearchfunding.org/pros-cons-gallbladder-removal/