Wednesday, September 05, 2012

What a Difference 9 Years and Another Country Makes

This afternoon Chris and I will be in the OBGYN's office for a short-notice ultrasound.

At my first prenatal visit yesterday the RN doing the medical history listened to a few of my symptoms, pieced a few things together, and said, "I'm getting you in for an ultrasound THIS WEEK."

So... that should be interesting. It's most likely nothing, but it might be something.

Her reaction panicked me a bit until this morning, when I realized...

The last time I was pregnant was 9 years ago and at the time I lived and received my medical care in Canada.

In Canada 9 years ago, it took at least 4 weeks of advance notice to get the single ultrasound for the entire pregnancy. I waited in the waiting room with a woman who waited 8 MONTHS to get an MRI for her debilitating migraines. The only place I could get an ultrasound was the local hospital.

Now I'm back in the US, covered by incredible heath insurance that we chose. We've maxed out our out-of-pocket for the year (the deductible is a distant memory). Our insurance covers all diagnostic tests the OB orders and all prenatal visits. Our insurance covers pretty much ANYTHING that's actually a good idea medically. Our insurance company does not have a history of Monday-morning-quarterbacking the doctors. We knew this when we chose our insurance coverage.

In Canada the medical system was (and is) run by bureaucrats. Bureaucrats more concerned with keeping medical costs in check than actually providing good healthcare. Bureaucrats more concerned with power than keeping people alive. Bureaucrats who don't invest in preventative care because preventative care is a cost they have to account for now. Preventative care doesn't make good statistics because you can't tie preventative care to a lack of bad consequences. When people die from lack of care it doesn't affect the bureaucrats one bit, other than "well obviously we'll pay for the hospital because you really need it." Never mind the fact that the hospital could be completely avoided in the first place. The hospital is easy to justify.

Our health insurance company thinks about costs differently. The health insurance company invests huge amounts of money in tracking patient outcomes. They figured out a long time ago that, as a whole, preventative care costs much less than handling avoidable outcomes. For this reason our health insurance covers "elective" surgeries like Lap Bands. The costs of treating obesity now are lower than treating the effects later.

So when our insurance company looks at prenatal care their default position is "diagnostic testing is good and useful." The entire point of diagnostic testing is to catch problems early when the issues are much easier (and cheaper!) to resolve.

When insurance companies understand this (and pay their bills properly) the doctors are encouraged to use new technology. The doctors KNOW they will get paid. The doctors know approximately how often they'll use different types of testing. The OBGYN's office decides its worth it to buy and keep their own ultrasound equipment and keep techs on the payroll.

So when a nurse sees something that worries her, she doesn't need to clear it with a bureaucrat. She just walks up to the scheduler and asks for the next available opening.

Thus how I ended up with an appointment for an ultrasound the next day.

We don't think about this is the US because we're so used to it. Can't anyone see their doc and get an appointment for a diagnostic test in a short amount of time? Aren't there enough imaging clinics and specialists around that the wait is never long?

The only reason I can get an ultrasound on short notice, and Chris can get an ultrasound within an hour (the case when the tumor was first discovered) is the high availability of the equipment and the people qualified to use it and interpret the results. The only reason we have high availability of diagnostic equipment is the absolute certainty that, once bought (and this stuff ain't cheap), the specialty equipment will be used and they will be paid for that use.

The moment you make it necessary to go through a bureaucrat to get a procedure approved and paid for, you take away that certainty. It becomes risky to invest in expensive equipment and new, more accurate, less invasive tests. If you're not sure you'll be reimbursed, why would you invest?

Which is why in Canada 9 years ago I could only be scheduled for one ultrasound, with a 4 week wait. Lots of demand but no ability (or desire) to invest.

Now my OB's office in a small rural town has its own diagnostic equipment, the people on staff to use it, and next-to-no waiting.

Now, when the nurse sees something that worries her she can put her (and my) mind to rest within 24 hours.

That's a big deal.

There is an even bigger deal here though, that I haven't mentioned. The reason the short-notice ultrasound was ordered is because I might have an ectopic pregnancy. The chances are low, but one major symptom is there and my chances are increased due to being on birth control at the time of conception.

If I was at all in pain I wouldn't have even waited one day. They would have sent me straight to the hospital. Since I'm not in pain, we're just going to verify that the fetus is in the uterus.

The chances are low, but ectopic pregnancies can be life-threatening if not caught early. My RN decided that the signs warranted immediate investigation so she made it happen.

Oddly enough, the same symptoms might mean twins, for which I'm also showing other possible symptoms. Immediate investigation is still warranted.

Either way, my RN made it happen.

My RN can do that. She doesn't need to call anyone. She doesn't need to check the list of "approved procedures" and "approved reasons." She can make it happen just by checking with scheduling.

Why the hell do we want government run healthcare again?