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OPINIONS
Dr. Timothy Saxe: Insurers put stress on the physician-patient relationship
Anyone who has ever been to a doctor knows that over the course of time, there is a special bond -- an often critically important bond -- that develops between physician and patient. These direct, honest and sometimes life-altering relationships are under a great deal of stress these days from insurance providers.
Insurance providers are making health care decisions about patients they've never met, and they try to force physicians to prescribe treatments based solely on cost rather than on what is best for the patient.
I have seen this in my own practice. Individuals who have spent five years using a prescription medication that has been successful for them are suddenly forced to switch to another drug because the insurance provider has changed its formulary or decided the drug is no longer "preferred" for some reason. Rather than allowing a person to stick with a medicine that has worked, the insurance provider requires another drug.
The insurance providers will tell you that they do this to help reduce the burden of health care costs. But the real impact of these decisions is that health care costs are driven higher for nearly everyone -- except, of course, the insurance provider who is forcing the change.
Here's an example: Your mother is on a medication for Alzheimer's, and it means she's able to live on her own. But one day, her insurance provider has decided it doesn't want to pay for that medicine anymore. She is forced to switch to a new medicine that is not as effective, and now, she can't live alone anymore. Her family has to help, or find help for her; she can't cook her own meals, she can't manage her own medications, and eventually, she becomes sicker. Her health care costs begin to skyrocket, and the cost to her family cannot be measured in dollars.
These decisions are often made by bureaucrats, not doctors. Or by someone in a different field of medicine -- psychiatrists, for example, making decisions about medicines for cardiac patients. All of the time they are made by people who have not examined the patient. This is a frightening and dangerous practice.
Insurance providers should, at the very least, follow the same code as physicians: a code that dictates the patient's interests come before any interest in monetary gain.
Additionally, this practice makes it difficult for someone who is ill to have faith that he or she is being treated in the best possible way. For example, patients may second-guess whether the treatment they are being forced to accept is in their best interest or that of the insurance provider. They may also wonder if the physicians they trust with their lives are really in the driver's seat. If a patient doesn't have faith in a doctor's treatment plan, that plan is far less likely to work. And if it doesn't work, that means people get sicker and costs go up even more.
As the debate over health care reform takes center stage, there are things you as an individual can do to make your voice heard on this matter and help ensure that patients are getting the most appropriate treatments as prescribed by their doctors:
1) Visit the Insure Patient Access Web site at www.insurepatientaccess.org to learn more about these issues. Sign the petition in support of the National Health Insurer Code of Conduct which is being put together by the AMA. Your support will help to ensure that these issues will be addressed.
2) Write and/or call your elected officials to voice your support for the National Health Insurer Code of Conduct and for protecting the doctor-patient relationship from the restrictive practices of insurance providers.
I would like to thank Highland Hospital, the Arthritis Foundation of West Virginia and the West Virginia chapter of the MS Society for already signing on to the petition in support of the AMA's proposed code, and I encourage other groups and individuals to do the same today.
Dr. Timothy Saxe has more than 30 years experience in the medical field and practices internal medicine in Barboursville.
