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A lesson in Healthcare Rationing
I love my cat, George. He is a great cat. A few days ago he began gagging and it went on through the night. By morning I was stepping on mini puddles of gooey slim throughout my house, Yuck.
I called the vet and they said bring him in. I have insurance with this veterinarian and office visits are no charge. So, I took him right in. Otherwise, I may have waited a few more hours just to feel certain it warranted the $50.00 expense.
After an examination the veterinarian began to list all the tests and X-rays she recommended. Even with my insurance it came to nearly $500; and that's just diagnostic work! I blanched, immediately thinking I should have waited to see if this was a passing thing. The vet waited for my answer. Within seconds I thought, I can charge $500 to my credit card (already thinking how I could pay it off over three months). Before my mouth and my heart went to auto pilot I asked myself what I would do if it were me. Here's what happened:
I asked, "If you do the X-rays what might you find?" She answered, "Some type of obstruction."
I noticed the line item, radiologist report and ask, "Can you read the X-rays?" She replied, "Yes, as long as there is nothing that raises questions beyond my expertise"
I asked, "What are you concerned about with the blood work?" She said, "Because George goes outside perhaps he has ingested some toxin. If so, we may need/want to flush his kidneys with an IV drip."
"How much is it to do the flush without the test?" She looked surprised but responded, "The test is $125. The IV treatment is $150."
After considering my position I said, "I respect you and your opinion; I just cannot afford to spend money unwisely. What if we take this one step at a time? I want you to do the X-ray and see if you can identify a problem. Then call me if you need a consult with a radiologist. Once an obstruction is ruled out, how do you feel about doing the IV flush of his kidneys without the test? Quite frankly, if that fixes the problem I don't need to spend $125 to know what the source."
She agreed to my rationing plan and called me later to go over a revised treatment plan.
The X-rays provided no evidence of obstruction or need for further evaluation. Rather than do a kidney flush she advised a hydration treatment, test for giardia (negative), a shot for nausea, and prescription for a medicinal coating for his stomach and intestines. Total cost to me $291.00. Twenty four hours later George was back to normal.
Did I handle this perfectly? As a single woman relying on a cat for companionship I likely took him to the vet sooner than a family with three kids living paycheck to paycheck. And, I know I was more frugal than many other pet owners. The lessons in this story are:
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Whether it is a pet or a family member, available resources will determine available options.
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Those services for which we do not have to pay directly will likely not be questioned.
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Sharing responsibility in the decision making process provides an opportunity to optimize cost and benefits.
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It's difficult to establish standards of care when resources are significantly different.
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