US Healthcare System: Dos and Don'ts
Recommendations for Patients in the US Healthcare System
If you have never been a patient in the US healthcare system before, you might feel quite intimidated about the prospect, and that’s understandable. Despite the fact that Americans spend around $3.5 trillion every year on healthcare, the US is ranked only 37th among 100 countries rated on the quality of their healthcare systems. Americans spend far more on health than any other country in the world, yet the life expectancy of the American population is shorter than in other rich countries that spend far less and has even declined since 2014.
However, if you find yourself needing medical care in the US, don’t despair. Here are some dos and don’ts to help you go in with “both eyes open,” as they say.
Dos
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Remember it's all about money
The United States is the only industrialized country without a universal health care program. Instead, the healthcare system in the US is largely a consumer-based business model. By the year 2021, spending on healthcare in the US is expected to rise to $4.8 trillion. Sadly, it is estimated that 30% of that amount is wasted, largely on unnecessary testing and treatments.
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Get everything in writing
You will need proof of what has been done. Try to receive a comprehensive after-visit summary as well as a written plan of proposed treatments. You should also be given an itemized summary of the costs incurred during your visit. Any planned treatment should include a cost estimate that summarizes what your insurance will pay and what your out of pocket or co-pay expenses will be. However, be aware that it is usually underestimated.
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Allow plenty of time
Allow plenty of time for medical visits or consultations (at least twice as long as you would in most European countries, for instance). Delay is the rule; this is sometimes due to emergencies but more often, overbooking is the reason. Remember, time is money, and doctors lose precious time when patients don't show for their appointments. What this means for you is that you will spend much longer in the waiting room than in the exam or consultation room.
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Realize that you'll probably only get to see the physician for five or ten minutes
To make the most of this time, be prepared with all of the information you'll want to convey to your doctor about the state of your health and how you've been feeling. Researchers at Ohio State University recommend writing out your concerns a day or two in advance of your appointment so you won't forget anything. You can even fill in their handy worksheet to take along with you. -
Ask your physician a lot of questions...
...and run away if he or she doesn’t answer them! Again, prepare by writing down your questions and concerns and bring this list with you. If you don't understand something your doctor tells you, ask for clarification. You should not feel rushed or that your doctor doesn't have time to answer your questions and concerns. -
Ask anybody touching your body to confirm that they washed their hands beforehand
Healthcare providers should always make this a priority, and especially during a pandemic you should expect utmost attention to be given to sanitization protocols, including the use of disinfectant, sanitizer, gloves, and masks. -
Ask the medical reason for every proposed or treatment
Why should I have it? What are the alternatives? What are the risks? Is it necessary to do it now? Unnecessary procedures are sometimes ordered just to increase profits, especially when a patient has insurance. In other cases, only one type of treatment is ever presented to the patient. But it is your health and you have the right to ask questions and get satisfactory answers. If this is a problem for the physician, you can and should go elsewhere.
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Be persistent until you reach the right person
Be persistent until you reach the right person (often the manager) to solve a problem. If you encounter a problem, whether it is a billing error, a problem with a medication, or you simply feel that your doctor has overlooked something important regarding your treatment, don't give up in getting the matter to the attention of someone who can help. You might have to go through a few different people to get results. -
Always ask for a second opinion
In 88% of cases, it will change or refine the diagnosis. It is quite common for patients to get a second opinion after an initial diagnosis or before surgery or other treatment. Your doctor should not object, and it is in your best interests to do so. -
Stay polite and follow the rules
It can be very frustrating trying to get a problem resolved or a question answered. But if you can remain positive and friendly, you will get better results than you would by venting your frustrations, becoming aggressive, or threatening. -
Avoid conflicts involving lawyers, if you can.
Especially if you are in a hurry or very sick. Legal cases are notoriously time-consuming and can take several months or years to be resolved. Fortunately, if you follow the above list of dos, you should be able to stay out of court and resolve any problems, if not on your own, then with the help of a competent and caring patient advocate.
Don'ts
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Be too naive (it's all about money)
It might seem like we're advocating a high level of cynicism here, but if you're aware of the reality, you won't be an easy target for those who would try to take advantage of your limited experience as a patient in the US healthcare system. -
Think that a physician will call you back
Think that a physician will call you back, always see you after operating on you, or coordinate your care with another physician. Some doctors provide this level of care, but they are the exception, not the rule, in an overburdened system. -
Hesitate to bargain over prices like you would in an oriental market
If possible, before the treatment so that you can still run away if necessary. Not very Swiss but it does work miracles. An article in US News & World Report recommends studying your bill carefully, researching the typical pricing for procedures, and then picking up the phone to find out if there are any waivers, discounts or relief plans that you can take advantage of. -
Panic: your choices are many
Much more so than in other countries. This will especially become apparent if you ask questions, do your research, and seek a second opinion. We've discussed many disadvantages of the US healthcare system, but on the plus side, the US has the most advanced equipment per capita, and is among the leading countries in medical innovations. The country's high physician salaries also attract some of the world's best doctors. -
Refuse to pay anything
There is close to no tolerance for this in the US. Outright refusal to pay a bill can land you in court, leave a bad mark on your credit history, and make it difficult or impossible to obtain financing for anything you need in the future. Remember, though, you can pay less if you negotiate, as mentioned above. If you're having difficulty paying in full, try to pay a little bit each month. Most hospitals will work with you if they see that you're doing your best to pay. -
Trust automatically
Maintain control by basing your trust on knowledge. Know who is working in your best interests, do your research, and understand your options. It's okay to "shop around" until you find a physician who earns your trust. -
Believe all hospitals are more or less equally performing
Some are terribly bad, a few others are among the best in the world, and most rank somewhere in between. One advantage of the "consumerized" aspect of the US healthcare system is that you can often find statistics and patient reviews online of medical facilities and physicians, so you can avoid the ones with atrocious reputations.
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Expect excuses
In the US culture, offering an excuse is seen as admitting that an error was made, which translates to: "I am guilty and therefore you are going to be able to sue me." -
Be weak: this is the Wild West of US healthcare
If you are not naturally assertive, you will need to find a way to be strong and defend your rights as a patient. Having a patient advocate at your side, for example, could make all the difference in the care you receive.
