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medpundit |
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Saturday, December 06, 2003If people were more fully exposed to the cost of their medications, wouldn't it be rational to decide that maybe the benefits are not enough? For example -- my anti-hypertensive costs X dollars a month to cut my risk of heart attack/stroke etc. by Y amount (I won't pretend to make up numbers, as a surgeon I have no idea what X and Y are) who should make the choice whether it's worth it? I have not formed an opinion on that, but everybody I've read on the subject takes up the debate as if that point is obvious. To me the question is if you handed the patient an extra $100/month and told him/her that they could use it to pay for medication or for McDonalds, would they choose the medication? And for those that choose McDonalds, why should the company think that their health is worth more than they do? Interesting point, and it's actually a conversation I had with a patient yesterday. He's had no insurance coverage for over a year now. He gets his diabetes medication from the pharmaceutical company under a hardship program. He's not taking his cholesterol medication, nor is he taking his ACE inhibitor to protect his kidneys. I usually see diabetics whose disease is well-controlled every six months, but he's seeing me once a year. Ditto with the lab work to monitor his disease. I wrote his orders for his lab work on three different order sheets and told him which I felt was the most important and which the least important to get, so he could find out the cost and make the decision which to have done. He reminded me three times during the visit that he "scraped and scrambled to get up the money to come in," but then as he was leaving he mentioned that he was considering radial keratotomy. Would he be a good candidate? The cost? $1500. (I didn't ask where that money was coming from. Maybe he hit it lucky in the lottery.) Being able to do without glasses is obviously worth more to him than taking optimal care of his diabetes. Yet, it's his money, and his decision. Maybe he would be happier living fewer years without glasses than several years longer with them. It's not the choice I would make, but that doesn't make it wrong. Then again, I wasn't inclined to down-code his office visit to a cheaper than usual rate after that. (Which is something I usually do for him, although he doesn't know it.) Why should I subsidize his radial keratotomy? UPDATE: A reader wrote to excoriate my patient's ophtalmologist for offering him the older radial keratotomy procedure instead of the newer, more reliable PRK or LASIK. Indeed, he may have been offered the latter but used the older term to describe them. Our conversation was centered more around the economics of his decision, and the importance of attending to his diabetes, so the distinction flew past me at the time. For readers out there considering eye surgery, PRK or LASIK is superior to radial keratotomy. posted by Sydney on 12/06/2003 04:37:00 PM 0 comments 0 Comments: |
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