Monday, April 12, 2004

More On Medical Services

I have some anecdotal evidence for the Paul Stokes theory on the effect of scarcity on medical services. (You'll recall from his comments: "the demand for medical services is not so fixed: the more accessible (less scarce) medical services are, the greater the demand. Demand for medical services doesn't work the same as demand for most other things that are for sale. Usually if the supply of something goes up, the price goes down because demand stays about the same. But that's not true for medical services. And its especially true if they are free. Medical services get more scarce. If price, then, is not going to determine how scarce medical services are going to be allocated, some other system has to be in place.")

So yesterday, Easter Sunday, Kellsey and I found ourselves in the Emergency Room of Presbyterian Hospital in Charlotte. I'd woken up that morning with what the ER doctor told us was "Positional Vertigo" caused by an viral-caused inflamation of my inner ears. This essentially meant that unless I held my head very, very still in one certain position, it felt like the room was rapidly and very unpleasantly spinning around me. This sensation was accompanied by the usual results of motion sickness, which is why I had to go everywhere with my own little plastic bag lined garbage can.

(If you'd like to know what I feel like every time I turn my head do the following: take a baseball bat or tube of the same length. Put one end of it on the ground and, bending over, place your forehead on the other end. Now walk around the bat, pivioting on your forehead. Walk around 7 times and then stand up and try to walk in a straight line. That's how I feel, unless I keep my head very, very still. Thankfully, sitting in front of a computer is a non-head-moving event.)

In case you were wondering, Easter Sunday is a very popular time to go to the ER. We waited for about 6 hours to see the doctor. While I would have preferred to see one sooner ('cause they eventually gave me Valium. Yum!), I was ok to just sit, hunched over, in a chair and watch BET Gospel Sunday Mornings, Hardball, starring Keanu Reeves, and Kindergarten Cop, starring Governor Schwartzenegger. (Later, when finally in an examining room, I also got to watch Phil Mickelson win the Masters. Hooray for Phil! Kells and I about teared up watching him finally win his first major, and the Masters, no less!)

Anyway, the waiting room was full. Kells and I were the only ones there who met the White, Under-30 demographic. For almost the whole time our other waiting room friends were minorities and a white elderly couple. Almost everyone was, like us, content to sit and wait and wait for our turn. No one in the waiting room was in obvious trauma.

After we were there about two hours, a man in his latre 30s/early 40s came in with a friend of his and sat down next to us. He was having an asthma attack and when he came in they gave him a nebulizer and medicine to treat the attack, but had him wait in the waiting room to see a doctor after he was stabilized. After about an hour of waiting, he started asking us around him how long we'd been there. When he heard that he was waiting behind people who had already been waiting for now 3 hours, he got a bit upset.

He commented to his friend, "Man, next time this happens, I'm just calling an ambulance, 'cause my insurance will pay for it and they take you right in when you come in an ambulance." Finally, about 20 minutes after that comment, he said, "Forget this s#*&, I'm fine now, I'm just going to pay what I need to pay and leave." So he ripped off his hospital wrist band and walked out of the waiting room.

I was struck by his willingness to use his insurance company's money to pay for an ambulance ride (which are not cheap) for a non-emergency event, simply to keep him from having to spend the day in the ER waiting room. And, by the way, jump in front of the line of us who were waiting to see an ER doctor.

I am happy to report, though, that this man was the exception in the crowded waiting room. Everyone else there seemed content to wait, even celebrating the moments when one of us waiting-room-folk would have our name called.

Between bouts of nausea (caused by the vertigo and Kindergarten Cop), I thought some more about this man's comments. It reminded me of the time I was at the dermatologist having some moles examined. Some of them warranted a biopsy to check for cancer (all negative btw), but one prominent one didn't warrant the check. However, the doctor offered to "fudge" his report so that, if I wanted, he could remove that mole and would write it up so my insurance would pay for it.

Besides being unethical (the nice way to say "fraudulent"), the reason I didn't ask to do this was that InterVarsity is self-insured. That means that everyone in the Fellowship pays into what you might consider a Medical Savings Account (MSA) that InterVarsity owns. When someone in the fellowship gets sick, the Fellowship pays for that out of this account. (The account is administered by GreatWest, but the money is ours.)

So my thoughts went something like this: "Hey, I've always wanted to get that mole removed, now's the time!" "Wait a second, that money's for other staff people when they get sick. They're counting on that money being there." "Besides, the Fellowship has had so many illnesses lately that the MSA is almost overdrawn." "Oh, and I think it would be insurance fraud, too." "No, I don't think we'll do this today."

After these two experiences, I can see how having an MSA would incent one to spend less and only when necessary.

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