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Cost and Consumerism

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Cost and Consumerism Presentation

Cassie Springer

HCO/HC 561

Carol Szerszen

May 16, 2011

Introduction

In today’s economy, insurance is not always an option. Below are some scenarios and discussion of out of pocket expenses and options for paying for treatment.

Scenario 1

A single, 23 year old female who is generally healthy, is a non-smoker, non-drinker is pregnant and without health insurance. She must find options for paying for prenatal care and delivery of the baby. Option one in the state of Kentucky would be to apply for Medicaid. Under Medicaid eligibility requirements most women will qualify if they meet the poverty guidelines (CMS.gov, 2011 ). If she were ineligible for Medicaid a second option would be to go to the local Health Department where fees are based on income. The Health Department has an OBGYN on staff full time. The Health Department also works with the University of Kentucky for delivery and other necessary testing she may need. If she were unable for any reason to qualify for services at the Health Department, the costs would be expensive.

According to CostHelper.com prenatal visits could approximate to be around $3200. That’s not to mention the cost of delivery. A vaginal delivery with an epidural could range around $8000, if a caesarian section would be needed the cost could range to be around $30,000 (CostHelper, 2011 ). Financing this would be out of the question for someone this age. If she were to make a minimum payment of $25 a month for a simple delivery and prenatal care, it would take nearly 40 years to pay off. She would be better off filing for bankruptcy. In this situation consumerism does not have any influence on the decision making power because of the time frame. It’s not just looking for a new Primary Care Physician.

Scenario 2

A 55 year old male that is a former smoker is found to have Lung Cancer and also has no insurance. His options for paying for surgery and or chemotherapy treatments are as follows:

Option 1: Under the eligibility requirements for Medicaid, he would qualify as medically needy and would be covered for the entire treatment including surgery (CMS.gov, 2011). However, there may be a monthly premium to pay.

Option 2: The local Health Department would work with the University of Kentucky Oncologist to ensure that the patient gets the necessary treatment needed. However, some out of pocket expenses may incur.

If a patient were to pay out of pocket for lung cancer treatment that would include surgery it would be around $40,000 (Surgery.com, 2011) for the surgery and hospital expenses and $3000(Peck, 2009) per chemotherapy treatment with labs included.

Because of the time constraint, the patient would have no choice to pay the fees. So, consumerism would have no factor.

Scenario 3

A 10 year old male has discovered he is diabetic. The options for his parents would be to qualify for Medicaid. If the parents do not meet eligibility requirements for Medicaid, they may meet the requirements for KCHIP (Kentucky Children’s Health Insurance Program) where there is a monthly premium that is based on income. Also, the local Health Department is also based on income and has a pharmacy on site where cost of insulin and other diabetic supplies are at a minimal fee. Out of pocket cost could be around $850 per month (Diabetes 360, 2010). As far as consumerism, there are some influences. Some diabetic testing supplies are now offered over the counter, which, if paid out of pocket, will save money. The best thing for a diabetic is education. Learning how to eat right, exercise, and keep close track of their own blood sugar is the key to keeping their cost down.

Scenario 4

A 60 year old female, who has chronic arthritis, but has no insurance, is seeking options. In this situation the options are limited. She does not qualify for Medicaid because her condition is not deemed medically needy and she is not old enough to qualify for Medicare. Treatments may include surgery, physical therapies and expensive medications – for example, cutting-edge biologics – that can add up to more than $2,000 a month, according to a July 2010 study by Consumer Reports magazine (Jacobs, 2011). With these considerations, the options would be to seek treatment through the local Health Department where the fees are based on income or to use over the counter mediations that may not work as well for the inflammation and pain caused by the arthritis. There are not many choices available for treatment, so consumerism would not affect the patient’s decisions.

Conclusion

There is a tendency among consumers to seek high quality at the lowest cost as a criterion of consumerism (Schneider and Hall, 2009). This tendency implies the necessity of a consumer to compare various products and then shop among vendors to find the best price. In some cases it is not possible to “shop around. “ The patient’s income or insurance status simply does not allow this to happen.

References

CMS.gov (2011). Medicaid Eligibility. Retrieved May 16, 2011 from

http://www.cms.gov/MedicaidEligibility

CostHelper.com. (2011). Baby Delivery Cost. Retrieved May 16, 2011 from

http://www.costhelper.com/cost/child/baby-delivery.html

Diabetes 360. (2011). The True Cost of Diabetes. Retrieved May 16, 2011 from

http://diabetes360.blogspot.com/2010/01/true-cost-of-diabetes.html

Jacobs, C. (2011). 9 Ways to Save on Rheumatoid Arthritis Treatment Costs. Retrieved May 16, 2011

From http://www.lifescript.com/Health/Conditions/Rheumatoid_Arthritis/9_Ways_to_Save_on_Rheumatoid_Arthritis_Treatment_Costs.aspx

Peck, P. (2009). Cancer Treatment Costs Worry Oncologists. Retrieved May 16, 2011 from

http://abcnews.go.com/Health/CancerPreventionAndTreatment/story?id=7715284&page=1.

Schneider, C., & Hall, M. (2009). The patient life: Can consumers direct health care? American Journal of

Law & Medicine, 35(1), 7-65. Retrieved May 16, 2011 from

http://www.rodbrace.com/article/consumerism

Surgery.com. (2011). Actual Costs of Cancer Surgery. Retrieved May 16, 2011 from

http://www.surgery.com/article/how-much-cancer-surgery-cost

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