In case you missed it over the weekend, we ran a piece from our November issue by health care expert Harold Pollack, explaining how, even though he's an expert, when it came time to manage his wife's care, he didn't make all the right choices:
Several people made mistakes in Veronica's care. The worst and most deadly mistake was ours: going to this urgent-care center. Veronica's symptoms demanded a 911 call. I knew better -- or I certainly should have. I am a certified expert, director of the University of Chicago Center for Health Administration Studies. I've served on expert panels of the Institute of Medicine, no less.
I was swayed to discount what was happening --Veronica, a clinical nurse specialist, was, too -- by disbelief, by her recent illness, and by her general fitness. We were also swayed by the expected hassle and expense of an ER visit. We envisioned paying a large bill to be prescribed some Tums. Last year, Veronica went out-of-network for urgent care. That cost $700.
In part, we hesitated because that was exactly what the modern health-insurance system is designed to make us do. A quarter-century ago, the RAND Health Insurance Experiment (HIE) established the basic argument for deductibles and co-payments in insurance. HIE remains the most important policy experiment in American history. Its most potent finding was that people who got free care used 40 percent more services than did others assigned to cost-sharing plans. Yet the free care produced little measurable additional benefit for the average patient. These results are often cited in support of co-payments and deductibles designed to discourage inappropriate care. Policy-makers and payers are particularly concerned about the real and alleged over-use of emergency care. Charging higher co-payments is one obvious response.
--The Editors
