Simple yet brutal solution: make reimbursement of doctor's fees conditional on improvement in the patient. Then place a tag in the medication, one that can be blood-tested. If the patient doesn't show improvement and fails to show sufficient levels of the tag, insurance doesn't pay the doctor's bill.

I'm sorry, but once the doctor has explained the regimen, given the medicine, and answered any questions, their job is done. Now it is up to the patient.

Welcome to America, where we eat McDonald's every day and then try to sue them for making us fat; where we refuse to follow a doctor's orders and then are baffled when we don't get healthier.

Right. Because punishing someone else for a patient's non-compliance is going to make the patients take their meds... That's so stupid.

How about YOUR insurance doesn't cover YOU when YOU don't take your meds and YOU are forced to pay for your doctor's bills out of pocket? Maybe you'd comply then when something is actually at stake for once. No sense in punishing the doctor - he held up his end of the bargain by seeing you, figuring out what is wrong with you, and outlining a way for you to fix it!!! All you have to do is follow his orders! But of course, if you don't, that's the doctor's fault, too. Genius. Patients are FAR more likely to make intelligent health decisions when there is a cost component that directly affects them. Most of the reasons patients end up in the doctor's office to begin with is due to their own lifestyle choices. Why don't we start holding them accountable?

I think the implication is that if the doctor isn't paid, then you have to pay the doctor.

I don't have insurance, though, so it won't work with me. Personally, I could never remember my thyroid pills (which I've had to take every day for 45 years) until the computer age: an Outlook reminder every morning with the pills by the monitor. Even then if I forget to turn on the monitor on I can sometimes forget the pills.

choirgirl3377:

I'm sorry, but once the doctor has explained the regimen, given the medicine, and answered any questions, their job is done. Now it is up to the patient.

Welcome to America, where we eat McDonald's every day and then try to sue them for making us fat; where we refuse to follow a doctor's orders and then are baffled when we don't get healthier.

OK. does it affect your opinion at all if I told you that right now I, who am pretty healthy, am on a prescription that costs $250 a month? And that though my insurance covers 70% of it, there is also a $1200 copay, so that I'm coughing up $8 a day every day, through May. (that rhymes; hey!)

yeah, I know, just cut down my coffee by 5 cups per day and that will cover it. trouble is, i don't drink 5 cups of coffee a day to begin with.

but I can handle it; what does the little old lady down the street who's got double the costs and half the income do?

did anyone here actually read the article?

they talk about the complicated reasons for the problem- the most basic inadequate time between doctors and patients. how does that boil down to people being fat , lazy, irresponsible or stupid.

the articel cited that if a patient asks a question they are interuppted within 18 seconds. people are not receiving adequate healthcare because of our system. you may disagree about the ways to fix it but we know the whole hmo thing is broken and killing us.

it has little to do with personal responsibility if people have inadequate time and explanation from their healthcare providers.

If you follow the links, you'll find very little proof of the author's assertions. The 18-second statistic, for example, comes from a single study conducted in 1984--not exactly documentation of the current state of the health care industry.

A second claim is that patients are more likely to comply when doctors spend more time answering their questions. I propose an alternative: patients who tend to comply seek out doctors who answer their questions. Patients who tend not to comply end up with doctors who spend less time (or seek out doctors who pass them through the office faster). My alternative also fits the facts, but in this case, forcing doctors to spend more time with patients would have no effect.

What can you actually take away from this article? That people don't take their medications even when it's important for them to do so. Sometimes this is because of cost. Any other conclusions are purely speculative.

Your alternative fits which facts? Seems what you say is more about your political outlook than any facts in the article. There may be some merit to the idea of that people that adhere choose docs that spend more time with them but there isn't any evidence for that in the article. And since most health plans allow little true choice of docs I don't think the theory would hold up under any scrutiny....

The other thing is - I don't think anyone is talking about forcing docs to spend more time with patients. Much to the contrary it is that they are unable to spend much time with their patients not unwilling.

This was one of the best summaries of the issue I have ever read. I would add that pharmaceutical companies are key to solving the problem. I know of a drug used to treat MS, which has adherence rates of 95%, because of the patient support program launched by its manufacturer. Because the drug costs $20,000/year, they can afford to provide "gold standard" assistance, addressing motivation, knowledge, skills, tools, reinforcement, social support, peer support and financial assistance.

If you compare pharma companies to airplance manufacturers - they build great planes, but they have the terrible engines; therefore they never offer enough thrust to get the planes off the ground - and most patients drop off therapy within 100 days. Clearly a better engine is needed. My blog on medication adherence is here: link

My point was that the study's authors showed a correlation, but did not establish causation. In my example, patients who spend more time thinking about their health seek out doctors who spend more time with them. As you've noted, there's no evidence in the article that this should be the case. On the other hand, there's no evidence of the other assertion either--that patients are more likely to comply because their doctors spent more time with them.

If causality goes one way--more time with patients leads to better compliance--doctors should be given incentives to spend more time with patients. If it goes the other way--patients seek out specific types of doctors--those incentives would be wasted resources, at least in terms of patient compliance.

Anyone who takes a stats class will hear at some point that "correlation does not equal causation". Here we've got a correlational study that the author of the Slate article chose to interpret as causal, which many readers will probably take at face value. I'd just like people to spend more time checking out the sources and thinking critically about what they mean.

I work with dialysis patients, and can tell you they get assistance with their meds if they can't afford them. We find a way to get meds for them, one way or another. I think the main problem (one mentioned in the article) is inadequate information. I have many patients that are noncompliant, but after I sit and talk to them about the how, why and consequences of their actions, they tend to be much more compliant. I think (and work with a few) healthcare providers are so overworked they simply don't have time, or forget that not everyone knows what they know. When you do something for so many years you tend to forget that even the most basic things to you are completely foreign to some patients. With all that said, I don't always take my meds either. If the doctor refuses to address my concerns, I don't follow his tx advice. Not the greatest idea, I know. If healthcare workers simply took the time to explain the entire situation to the patient, I think it would make all the difference in the world. Would you do something you didn't want to just because someone you pay told you to?

So the insurance co. doesn't pay the bill. The doctor has to pay his staff to send the patient the bills, possibly hire a collection agency, the patient could eventually file bankruptcy and the doctor gets nothing ---- this helps how???? The doctor is the one paying for the patient's noncompliance.

And - I'm sure the ACLU would have a major problem with chemically "tagging" a pill.

Granted doctors are rushed and patients get shortchanged. I think patients have more power over that than they exercise. My Rheumatologist tends to not only interrupt me but to talk over me - I told him to be quiet and listen to me. If patients start leaving doctors and going elsewhere then maybe doctors will get the hint. It is the patients that give the doctors their jobs afterall.

Not to mention the added trauma and costs involved in every single patient who gets put on medication getting a follow-up check of the bloodstream drug level. I know a few pediatric patients of mine who wouldn't be too keen on this idea.

'One in three families had to skip medical care because of cost, and 25 percent had serious problems paying for the care they needed, according to a survey of more than 26,000 people released Tuesday by the AFL-CIO.

Most of the survey respondents were employed, college graduates, union members and had insurance, a group that AFL-CIO President John Sweeney said "you would expect to have positive experiences with America's health-care system. They're hurting." '

- Health insurance costs worry workers; 1 in 3 skipped medical care because of the cost
Francine Knowles; The Chicago Sun-Times; Contributing: Associated Press
03/26/2008
Chicago Sun-Times
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