The Urgent Need for Healthcare Consumerism

Just last week, I heard from a friend who complained that she recently waited four hours at the emergency room after spraining her wrist. 

“Why did you go to the emergency room?” I asked shaking my head, the disbelief rising inside of me.  “Where else would I go?” she said in an atypical, matter of fact tone.  “Urgent care or a ‘Doc-in-the-box’,” I responded.  “But I was in pain and I didn’t know they could handle something like that,” she responded.

Wow!  It sure would have been worth a try. But if she doesn’t get it, how can I expect someone with a lot less education to make informed decisions?  With health care reform looming in 2014, (heck, just because it’s the right thing to do), people need to familiarize themselves with the definition of ‘emergency’ and act accordingly to not waste the resources we have, not to mention their time and money.

My friend is a well-read college graduate but clearly lacks common sense. Her hospital’s urgent care or even one of the many “Doc-in-the-Boxes” would have been a perfect destination for the treatment of her sprain. Last I checked, a sprained wrist wasn’t life threatening. Yet, I consider her poor decision making to be partly the fault of her insurance company, whoever they are. There should be consequences for making an expensive, unnecessary choice. And if there are consequences with her insurance company, she may not even be aware of them.

It’s no surprise though, that people without insurance and those from lower socioeconomic groups are using the ER as their primary care physician. A waste of resources plus these facilities oftentimes aren’t reimbursed. A double-whammy.

So what does it take to become a savvy consumer of health care?  Just shop for insurance, health care and procedures just like you would for a set of tires, a television or toilet paper. It desperately needs to become part of the vernacular here in the U.S. One way I believe that will happen is through education. Providers and payers alike need to publicize and promote the definition of what a smart consumer of health care looks like. Here are some of the traits.

1.)    Understands cost implications—considers the true cost of health care when making decisions. Makes appropriate health plan and provider selections too.

2.)    Practices self-care for such things as sprained ankles, cuts, bruises, burns, colds, etc. Makes a conscious decision, when appropriate and not foolish, to manage health problems on their own.

3.)    When the do have to access the system, they communicate clearly with health care professionals and share in the decisions

4.)    Takes responsibility and the initiative to manage their own chronic conditions—even to the point of participating in available classes and programs

5.)    Leads a healthy lifestyle—engaging in activities to maintain or improve their health. Practices prevention and knows what screenings they need and when.

Just think, my friend could have saved hours and probably the surprise of a major out-of-pocket expense she’s going to receive when her insurance company denies her claim.

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