Docs, Tests and Societal Healthcare Costs

Today's blog looks at different aspects of the cost of chronic lyme disease. I'm focusing here on practitioner and testing costs, following up on August 29th's blog about protocol costs.

First, here's the raw numbers to our question about how much we spend each month on our practitioner visits. (This includes practitioners we see in the emergency room.)

The good news is that most of us manage to keep this under $500/month. The bad news is that 15% top $1,000/month--just to see doctors.

And it looks like going to the ER more is a significant factor in making it more expensive. Here's those numbers:

It looks like patients who use the emergency room as a more significant part of getting care, unsurprisingly, spend more money on average on their care. (That is probably a no-brainer statement, but it is nice to have some actual numbers attached to it.)

The most unfortunate thing about this is the folks who are forced into using the ER because they haven't been able to get competent medical care and are unable to manage symptoms in a less-than-crisis-filled manner. It clearly isn't cheap (for either individuals or the broader society) to be using the ER to meet your doctor needs.

Another place where we get some variation is in the type of practitioners we see. Here's a simplified chart with the numbers for folks who are seeing some type of lyme literate doctor:

As a very general statement, it looks like patients seeing Osteopaths spend a bit less, and patients seeing Nurse Practitioners spend more. That struck me as curious. Why would seeing an NP drive the price up?

I wondered if this might be because NP's tend to have less in the way of prescribing rights than MD's, and if this might mean that someone seeing an NP would be more likely to also have to see someone else for their meds. But this ought to be true for at least some DO's and ND's (whose prescribing rights vary from place to place, just like NP's do).

Maybe it matters because NP's are more likley to use antibiotics in their practices (which require a prescription) than DO's or ND's are, and so it really is about prescribing rights? Hmm... curious.

I did find one other potential factors as I was fiddling around with the numbers. I'll share these numbers in later blogs, but one thing I did find was that MD and NP patients use the emergency room more than ND and DO patients do. So perhaps it is the combination of these two factors (needing a back-up prescriber in some cases and ER usage patterns) than make NP care more expensive?

This goes into the bin with the growing list of other "things Ma'ikwe wants more info about".


 Is this a Test?

OK, so far we've looked at the cost of various protocols and of our practitioner visits. Now let's look at testing. Many of us have been poked, prodded, cultrued and drained more times than we care to remember.

Sometimes testing is to get a diagnosis (actually diagnoses would probably be more accurate, given that we rarely have just one tick borne disease), but then a lot of doctors also monitor our thyroids, livers and CD57 levels, assess us for allergies, check for other viruses that have gotten reactivated by our compromised immune systems, check our genetic profiles and hormones, look for damage to our hearts, brains and joints, and a host of other things.

Sometime the testing seems never-ending... and so do the bills associated with them. Here's what that looks like:

That's right: 25% of us have spent over $50,000 on testing alone, with another 20% coming in with collected bills of over $20,000. Lyme just isn't a disease I'd recommend to the poor or uninsured. And that's unfortunate, because the borrelia bug doesn't pause to find out those statuses before settling in.

One of the things I found myself wondering was how much of this was spent before we ever got a good diagnosis? In other words, how much of these big bills would be avoidable with better attention from the medical community on lyme as a real and dangerous illness early on in the process? (Into the bin those questions go.)

There is also a second category of potentially avoidable bills. Even after I knew I had lyme, but was not yet particularly lyme literate myself, I feel like we did tests that a lyme literate doctor might not have felt the need to do. For instance, I had several thousand dollars worth of cardiac assessments prior to understanding that babesia can mimic cardiac issues.

Had my doctor at that point been lyme literate, we might not have run those tests at that time. Or we might have: knowing that I don't actually have heart damage (which lyme can surely cause) at this point is a useful piece of information. But $3,500 out of pocket worth of useful? That's what I'm not sure of.


Finally, your practitioner's treatment and tracking philosophy can make a big difference in how big these bills are. Some people are getting their CD57 checked every 8 weeks. Some people have never gotten it checked. Some people's livers really do need to be monitored, but some doctors need them to be monitored to track you within their own system they've developed.

In cases like these, I wonder (like with my cardiac evals) how valuable the information is, and how necessary all those tests are. Different doctors will have different answers to this, and your doctor's philosophy on these questions is likely to be a key factor in how big your bills get.


A little on the Bigger Picture

Caring about this is easy (and automatic) if you are a self-pay patient. If you have insurance, however, how much should you care? The answer to that is certainly up to each of us.

However, the average annual cost of medicine in this country is very high compared to other "developed" countries (and our general state of health doesn't seem to be benefiting from "throwing money at it.") Check out this article for some stats on that. (And lest you be concerned that this comes from the Huffington Post with it's liberal slant, Fox business published the almost identical information here.)

Even while recognizing that we are not "average" patients, I think it is worth considering the societal costs as one of the many data points that factor into things like testing. Surely we should be able to do good medicine without needing to be the country that spends the most on healthcare of any nation in the world. If we are that smart, how come we haven't figure out how to do medicine more efficiently?

Finally, as you are considering how you feel about our new national healthcare bill, here's a quote to contemplate (which appears in both the Fox and HP articles):

Many of the countries that spend the most per capita on health care have highly privatized systems. In the U.S. and Switzerland, which spend the most and third-most on health care, respectively, the government pays less than 65% of the total health care costs. In most of the countries in the developed world, public expenditure accounts for at least 70% of total costs.

So there is a noted relationship between privatized medicine and high costs. It makes sense to me that the more you let profit run healthcare decisions, the more profit will run up our bills. Even if you don't buy into socialized (which isn't a dirty word in my book, but I know it is for many) medicine as the solution, I do think that looking at price controls and profit caps in some way would be of benefit to all of us.

Because the bottom line is, we all have better things to do (like getting healthy) than stressing over how to foot these big bills.