Insurers Push Plans Limiting Patient Choice of Doctors and Hospitals

The inevitable reduction of physician/hospital choice begins as employers redistribute the cost burden of the Obama healthcare legislation to their employees.

Back in July of 2009, I predicted what effects the Obama healthcare legislation would have on a consumer/employees ability to choose their physician. Unfortunately, I was correct. The July 18, 2010 New York Times reveals that the country's biggest insurers are promoting plans with reduced premiums that require participants to use a narrower selection of doctors or hospitals.

The trade off, they say, for these reduced price plans, is that more Americans will be asked to pay higher prices for the privilege of choosing or keeping their own doctors if they are outside the new networks. Surprise! Remember the repeated assurances from Obama that consumers would retain a variety of healthcare choices?

But choice - or at least choice that will not cost you dearly - is likely to be increasingly scarce as health insurers and employers scramble to find ways of keeping premiums from becoming unaffordable. Aetna, Cigna, United and WellPoint are all trying out plans with more limited networks.

The size of these networks is typically much smaller than traditional plans. In New York, for example, Aetna offers a narrow-network plan that has about half the doctors and two-thirds of the hospitals the insurer typically offers. People enrolled in this plan are covered only if they go to a doctor or hospital within network, but seeing physicians and hospitals outside the network will pay much more for the privilege.

With families paying an average of $13,000 annually for medical coverage, it is quite possible that with co-pays and deductibles, the premium penalty for choosing a top-tier physician and hospital might actually begin to eclipse that package rates of the identical procedure performed in India.

The choice will then between a local US physician/hospital whose medical outcomes are impossible to determine, versus a world renowned surgeon/super specialty hospital in India.

Transformational Healthcare

Data from hundreds of successful surgical procedures in India yield some surprising results

If you happened to watch the LPGA Womens Open this weekend, it is unlikely you would have noticed the effortless way that caddy Fred Schuler walked the course. It is difficult to imagine that earlier in 2009 he had collapsed on a golf course in Canada due to excruciating back pain. He could not walk upright, ride in a car...and was essentially unable to do much of anything without pain.

Working with IndUShealth and the surgical specialty team at Fortis Hospital in Bangalore, we arranged for an L3-L4 discectomy to be performed on October 29, 2009.

By March of 2010, he was able to run 2.5 miles, ride a bike for two hours, and resume caddying.

While there are many stories to tell about outstanding medical outcomes across the world every day, what is unique about the IndUShealth patient story is that hundreds of patients have experienced these outstanding results, with a 100% satisfaction rate...and dramatic cost savings.

There are dramatic differences between the way patients experience US vs Indian healthcare, and we now have enough patient data to draw some interesting conclusions.

The Indian physician focuses on healing the patient. Because of the way that the US physicians and hospitals are compensated for their services, it is impossible to escape the fragmentation of traditional healthcare. Every component of patient service is plucked and parceled out to a variety of practitioners, separated by time and distance. There is little time for any emotional bond to be made with a healthcare professional at any level.

In an Indian super specialty hospital, the US patient is the benefactor of having the complete attention of a physician who has vast experience, and whose medical judgement is not clouded by the financial distractions of their US counterparts. Rather than moving from procedure to procedure, the Indian physician must manage the individual healing process to such an extent that the patient can easily make the return trip to the US. This means that physical therapy starts immediately after surgery, and is continuous throughout the patient stay.

One important aspect of the healing process is not so easy to measure, and this the role that the patient plays in their own recovery. Patients who have confidence in their surgeons, and believe the surgeon is genuinely interested in their outcome have a better healthcare experience. The very simple act of an Indian surgeon giving a patient his cell phone number is a powerful example.

The entire journey to India is focused on healing. There is no question that it is a long trip from the US to India. And it is also indisputable that most of us in the US have a very low attention span, have little time to focus on specific tasks, and lead fragmented lives. A medical journey to India has the effect of focusing an individuals attention to the healing task at hand. The medical traveler has either been forced through life circumstances, or found the inspiration to think outside the 'US healthcare box' and commit to this decision. Many times their decision has been derided by colleagues at work, healthcare professionals in the US or myopic family members.

Another important distinction is that for some surgeries, such as bariatric, the Indian surgeon requires a patient to demonstrate committment to certain life changes prior to surgery. For example, smoking must stopped and certain weight targets must be met. This process begins an emotional investment in the patients healing process, which is typically absent in US system.

So quite unlike the meandering path experienced in the US, there is significant personal investment of time, energy and resources to the healing process in India.

The patient experiences a transformational healthcare milestone in their lives. For most of our patients, the trip to India is the first journey outside the US. This is a peak experience of world travel, exposure to new cultures, and being the benefactor of a 2600 year old healing tradition.