Misconceptions and Confusion in Healthcare Coverage Among Elderly Populations
A small podiatry practice in Northeastern Missouri becomes the scene of a tragedy which takes place in plain sight, as there is not a day that goes by where at least one or more patients will be charged for their office visit despite mistakenly believing they would be covered. Unanticipated medical costs can be devastating even for adults in their prime of their working lives, but for the elderly and infirm living on a fixed income and attending multiple physicians simply to survive, the burden of health insurance failing to cover their medical bills can be overwhelming to say the least. Approximately 75% of patients who are examined in this particular Missouri podiatry practice are over the age of 65, putting them well within the segment of society which is ostensibly enjoying their retirement years while managing a fixed income. Another thing that each of these senior citizen patients has in common? The answer is the shared misconceptions and collective confusion this age demographic suffers through when it comes to comprehending the vagaries of their complex healthcare coverage programs.
The vast majority of American seniors are receiving federal health insurance assistance through the Medicare program, and some are even fortunate enough to afford a commercial health insurance supplement to offset the costs of procedures and treatments Medicare will not cover. Although most seniors in this country are covered under Medicare, one disturbing fact has emerged from decades of government managed health insurance for the nation's elderly: it is not enough to purchase health insurance, you must understand its provisions in order to derive maximum benefit. Unfortunately, the process of deciphering a government-operated health insurance subsidy plan -- or its commercial counterparts offered by private insurance companies -- is increasingly defined by dense technical jargon, inaccessible contracts filled with fine print, and collusion between medical suppliers and hospitals to fix the price of basic care components. Just as the tax preparation industry has emerged to help young adults navigate the often inexplicable maze of the modern tax code to file their income tax forms properly, a system of advocacy for the elderly must be instituted which assists them in understanding their health insurance policies during this extremely vulnerable time in their lives. A comprehensive study conducted in 2013 study to assess the ways in which consumers misunderstand their health insurance coverage revealed that "in a question asked of a larger, representative, sample of senior citizens that included about one-third who were actually facing the choice of whether to enroll in Medicare part D, only 30% endorsed the statement that 'the Medicare Part D program is well designed" (Loewenstein, et al.) An objective organization must be created and made available on a public level to educate seniors struggling to identify the correct insurance plan, whether it be Medicare and its multiple Parts, Medicaid or a private insurer -- as well as to help seniors understand the plan they are currently covered under. This idea is intended to be far removed from the typical model of an anonymous insurance sales rep knocking on a senior's door or calling them on the phone, before putting on a pressure-filled pitch to sell them insurance plans that are exorbitantly priced while remaining woefully insufficient for their long-term medical care requirements.
Amidst the futile clamor and commotion of national healthcare reform legislation being debated on the national political stage, every segment of the medical industry from patients to doctors alike are searching for ways to effectively and efficiently trim the cost of delivering quality healthcare. While the inexcusable waste and graft of the insurance industry, runaway medical malpractice litigation and the importance of lifelong preventative care are all issues that have been thrust to the forefront of the political discourse, a tremendous leak in the system has escaped notice and continues to drain resources from both hospitals and those they treat. The threat of additional infections afflicting elderly patients who require treatment for an original condition is prevalent throughout American hospitals, and according to the U.S. Department of Health and Human Services "healthcare-associated infections (HAIs)" or "infections that elderly patients acquire while receiving treatment for medical or surgical conditions & #8230; occur in all settings of care, including hospital acute care units and same day surgical centers, ambulatory outpatient care clinics, and long-term care facilities, such as nursing homes and rehabilitation centers" (HHS Action Plan, 2011). Whether one attempts to gauge the overall price of healthcare-associated infections in terms of the financial expenditure, the human suffering or the diversion of valuable resources they impose on the healthcare system, it is quite clear that these typically preventable occurrences inflict significant costs across the country. Returning to the topic of misunderstanding health insurance coverage, a significant portion of these HAI diagnoses occur in hospitals which are ranked on the lower spectrum of objective ratings systems which track patient outcome and treatment efficacy data (ConsumerReports.org, 2014). With the nation's senior citizens increasingly saddled with subpar healthcare due to their insufficient knowledge of the insurance options available to them, contracting dangerous HAIs which continues the cycle by driving up costs and confining them to a hospital bed for extended periods of convalescence, it is clear that a distribution point for educational material and hands-on counseling for seniors exploring their health insurance options is desperately needed. Contemporary research confirms as much, with a 2012 study finding that "100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars" (Umscheid, Mitchell & Doshi).
With the miraculous advances in modern medicine which have been made throughout the last two decades, from the sophisticated diagnostic tools used to identify potential health problems to more efficient and effective pharmaceutical medications, the average American today has an expected lifespan of over 77 years. This figure represents an astounding leap forward from the average expected lifespan at the turn of the 20th century, which stood at a mere 49.2 years, and signals a growing focus within the health insurance industry -- including government programs like Medicare -- on covering patients during the end of their natural lives. Through a careful statistical analysis of census data, including birth and mortality rates, the medical profession has determined that "as a result of falling age-specific mortality, life expectancy rose dramatically in the United States over the past century," and when this fact is considered along with "decreasing fertility, the life expectancy gains have led to a rapid aging of the American population, as reflected by an increasing proportion of persons aged 65 and older" (Shrestha, 2006). Simply put, Americans are living longer today than any other demographic group in recorded history, and every day millions more septuagenarians and octogenarians cross the threshold into infirmity and convalescence. This trend has motivated health insurance providers and others tasked with the responsibility of caring for patients at the end of life, spurring calls for the establishment of guidelines and governing principles to regulate this crucial period in every person's existence.
The results of a 2000 study entitled "Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers" were published in the Journal of the American Medical Association, with primary author Karen E. Steinhauser concentrating her research on ranking the various priorities concerning patients, their families and the health care practitioners tasked with guiding them through the end of life. She and her colleagues employed an extensive cross-sectional, stratified random national survey conducted between March and August of 1999, studying clusters of seriously ill patients, recently bereaved family members, physicians, and other health care providers including nurses and hospice volunteers. By basing their research on the belief that "a clear understanding of what patients, families, and health care practitioners view as important at the end of life is integral to the success of improving care of dying patients" (Steinhauser, et al., 2000), the authors seek to improve the standard practices used during end of life care, while also contributing to the industry-wide discussion on how to best handle this extremely delicate aspect of health care delivery. Their rigorous scientific examination, focused entirely on the personal values held by those involved in end of life decision making, consistently revealed that "patients who were seriously ill identified freedom from pain, being at peace with God, family presence, cognitive awareness, and respect for treatment preferences as most important to them" (Steinhauser, et al., 2000). The work of Steinhauser and her peers clearly illustrates the abstractions involved in end of life care, showing that the rigid structure of general health care must be adapted to take emotions, faith, and familial relations into account.
One of the most vexing and heart wrenching aspects of end of life care is the fact that many patients in this state of health are left incapable of making the agonizing decisions which inevitably…