The more you pay the less you risk?

[kristina]

The more you pay the less you risk?
Having read different experiences people have had at Dialysis Centres, a question comes to my mind. Does there exist different levels of quality at Dialysis Centres, arising from different grades of Health Insurance (private) and State Health-care? In other words the more money you pay the better the service and smaller are the risks. I would really appreciate your thoughts. Thank you very much, Kristina.

[cat]

My husband and I are convinced that this is true.  When I got sick, was taken to the ER and diagnosed with kidney failure, I had no insurance.  I was 2 months short of going on Medicare due to medical disability that was not related to kidney problems.  I had to stay an extra 10 days at the hospital until they found an open chair at a dialysis center.  Hospitals have to take patients whether or not they have insurance; dialysis centers do not.  I was not even scheduled for the fistula surgery until both Medicare and the state supplemental insurance became effective – three months after I started dialysis.  If I had any problems with the catheter, the dialysis center would try to solve them.  If the center couldn't fix the problem, I was told to go to the ER.  After all the insurance was in place, I was sent directly to an interventional radiologist at a private center.  We are convinced that the extra time at the hospital, delay in the fistula surgery and referrals to the ER rather than direct referral to a doctor were all due to lack of insurance.  Now that I have full insurance coverage, I get everything I need in a very timely manner.  I do not think that is just a coincidence!

[RichardMEL]

Perhaps things are differnet here in the land of Oz. There's no Wizard (despite what the PM would have us think !!) but I am in a state run, but I think federally funded(yeah I am not sure of the specifics there) dialysis unit at the hospital. I don't pay a cent out of my own pocket for dialysis treatments or in-center delivered medications (like heparin or aranest/EPO). Obviously I pay by my income taxtes but given the govt spends circa $80k on keeping me alive and I pay a percentage of this in taxes it's a bloody fair deal!

I feel I get top notch treatment each and every time. They only use divisioon 1 RN's and I am totally confident that should things go wrong for me I have professionals who know what they are doing there to look after me. Sadly I've seen them spring into action on more than one occasion. Everything is single use only - no reuse and they are very clear on the protocols, goves, washing etc. I feel any risks of anything are as minor as they can be.

While we do have private dialysis units in this country that private health insurance would pay for my real understanding is that basically the main difference is they have better snacks!! Half of the staff in my unit also work at some of these private clinics, so in essence it's the same level of care on the medical side - probably moderately better facilities, entertainment options etc, at the private units (but I have not been to one myself to know for sure).

[jbeany]

I think a lot depends on if your dialysis center is a for-profit or a non-profit.  Mine is non-profit, and I haven't seen any difference in my care from when I had private insurance and now, when I've lost the insurance and only have Medicare and gap coverage.

[Wallyz]

Anecdotally, there is a difference in care between Private an public pay patients in for profit centers.  Usually this results from staff making exceptions to bad policies for private pay patients.

[kristina]

Thank you for your kind answers. There is another point generally under discussion which follows the same discriminatory pattern and that is "ageism" in the Health Service world-wide. That is, where older people receive less care then young people. I have no idea whether this exists but it is being publicly discussed and no one can explain why older people would be treated less well than young people. Another topic in the same bag is whether or not people with rare diseases are discriminated against. In my particular case suffering from MCTD/SLE I have noticed doctors at all levels shy away from approaching the management of my complicated disease and medical history.Thank you for your comments, they are always extremely interesting and valuable.

[aharris2]

Another topic in the same bag is whether or not people with rare diseases are discriminated against. In my particular case suffering from MCTD/SLE I have noticed doctors at all levels shy away from approaching the management of my complicated disease and medical history.Thank you for your comments, they are always extremely interesting and valuable.

When it comes to the rare and complicated disease, the right kind of doctor might be intrigued and challenged and welcome such a patient. Many more are not that right kind and you may simply scare them. This will be especially true for hospital visits if the doctors involved in your care have no history with you.

(Of course, it could be that you are HMO and that your complicated care with specialists visits hurts the primary care physicians bottom line and annual bonus. There's truth to this. Been there done that, but have persisted until at least part of our doctors are the right kind.)

[kristina]

Thank you for your most interesting reply and thanks for understanding. Please tell me, what is HMO?

[Epofriend]

It is a type of insurance (health maintenance organization). You have a primary care physician who refers you to specialists, usually a select group of specialists. Their goal is to keep costs down for the parent company and they are paid bonuses for doing so.

[kristina]

Thank you very much Epofriend, your explanation about the Insurance and bonuses is very much appreciated. It is often debated whether a bonus is given as an incentive to encourage people to work harder or an "incentive" to make them keep silent (e.g. the bankers etc.)?
But to continue my theme about discrimination, in the light of this reply about Insurance companies, I wonder whether the bonus scheme reaches far into the medical system and not only involves financial reward but also other types of "incentive" reward. In my particular case State-run Primary Care Trusts (PCT’s) are directly involved in partnership with Family General Practitioners (GP’s) who in reality are not employed by the National Health System (NHS) but run their own businesses with a contractual arrangement with the PCT to care for NHS-patients. The third party is of course the pharmaceutical companies. And between the three of them I often wonder what “incentive bonuses” exist in the PCT and GP-surgeries? The patient could become a victim of a system which they have no control over.
Many times I have experienced being sent to specialists who, as I thought, used me purely as a research guinea pig without considering me as a human being in need of respect for my condition and in need of treatment. These visits resulted in no outcome for myself and if I showed my concerns and questioned anything I noticed immediately a change in attitude. My questioning challenged them and I detected a subtle change and from then on the medical  care towards me deteriorated totally and I was really given no choice but to leave and request another referral where the same experience repeated itself. In the private sector most specialists also work in the NHS-sector, so, even if I could afford to pay privately where one would imagine one gets a totally independent medical opinion, it is a fact that because the specialist connection to the NHS they can simply run a check through the NHS-system on a patient's background, and this, it has been found, taints their approach to this patient, even as a private patient. So, whether the State or Private, the patient is dealing with only one Club. Such a system check-mates patients with rare diseases like myself. I have not yet succeeded in thinking or finding a way round this dilemma.