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:
Whether it is a pet or a family member, available resources will determine available options.
Those services for which we do not have to pay directly will likely not be questioned.
Sharing responsibility in the decision making process provides an opportunity to optimize cost and benefits.
It's difficult to establish standards of care when resources are significantly different.