Monday, July 16, 2012

Health Care Blues

The scenario:  A young woman, a member of a large immigrant population in our city and on state assistance, brings a prescription to the counter. It is from a prescriber who staffs what is commonly known as "urgent care" or "quick clinic" or by many other names -- a walk-in, no-appointment- needed type of area which is intended to address problems that are acute, or can't wait for a regular doctor's appointment.  Her prescription: Differin Gel (its generic form) -- a topical acne medication.  It costs over $200 for a 1- 1/2 ounce tube.  Her out of pocket copayment: Zero.   She collected the medication, picked her smartphone up off the counter, and was on her way.

Now, I know this is a sensitive topic.  I'm not suggesting that immigrant populations, or those on state assistance, don't deserve quality medical care.  Of course they do.  But does this qualify?

This nagged at me in so many ways.  Why is an "urgent care" provider seeing people for acne? (Don't get me wrong, half the stuff coming out of Urgent Care is not urgent).   Do they know that they have selected a $200 medication? Should it be covered under a state plan when many private insurance plans don't, or at least require prior authorization?

The fact that health care legislation is always in the news now makes me more aware of this stuff. I don't pretend to be an expert on all of it, but I can look at the prescription side of things and see a lot of things that don't make sense.  People sound alarm bells about the 'rationing' of health care.  We all know that it's already rationed.  Maybe there are some situations where even more "rational" rationing is not a bad thing at all.

Incidentally, I do know that the huge amount of time we spend processing, labeling and verifying over-the-counter medications for state plans is ridiculous. Forget the computer entry, the labeling, the piles of stuff to check, the impatient insistence and shouts of  "Is it READY YET???"  Let me hand the customer a bottle of Tylenol, tell them how many to take, and bill the state for one "over-the-counter" charge or some such thing.
No waiting, no labeling, no screwing around. 

Lately I am seriously questioning how long we can sustain this.