Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Our health system is a sick system

Heather Finlay-Morreale, MD
Policy
September 23, 2018
57 Shares
Share
Tweet
Share

Unhealthy behaviors such as smoking, overeating, or lack of exercise lead to chronic health conditions, and many patients wanting to make positive changes to their health may seek the advice of their doctor to do so. But our insurance payment system works against supporting people when they want to act in a healthy way, and some of these payment decisions seem rooted in prejudices against those suffering from certain conditions.

Smoking cessation seems like something insurance companies would support. Fewer smokers means fewer heart attacks, strokes, and cancers. How can you not support people quitting smoking? Yet insurance companies do not pay for smoking cessation efforts in any meaningful way.

In 2014, the Affordable Care Act mandated coverage for smoking cessation, but the payment is roughly $20, and the number of visits is limited per year. So you cannot see a patient only for smoking cessation ; you need to have another reason to code to get paid for the visit.

For example, I have a healthy young patient who wants to quit and is interested in varenicline or bupropion. This would take multiple office visits for management and counseling, but, unless I can find another code to use, insurance will not pay more than $20. Insurers also have varying coverage levels of nicotine replacement products and prescriptions for curbing smoking. The out-of-pocket costs for these products are substantial and in themselves are a barrier to people quitting. This is a clear example of not thinking of the big picture. Insurers are paying for the COPD or cancer from the smoking, but not for the treatments to prevent the disease. This is a sick system, not a health system.

Obesity is another major health issue. Over one-third of children are overweight or obese. Helping a family change their lifestyle and make healthier choices takes time. Yet I cannot bill just for obesity as a code for an office visit and get paid. Insurers will pay for asthma, allergies, a laceration, even an ingrown toenail, but not obesity. Nutrition counseling is covered to a variable degree and often limited in visits. Some insurers require an additional health issue such as diabetes before covering nutritionist visits. No insurer that I know of covers visits to a exercise physiologist or trainer. At best, an insurer might give a slight discount on a gym membership. There is absolutely no support given to people trying to lose weight. Again, a sick system, not a health system.

Opioid addiction , another huge issue. Medication-assisted treatment (MAT) is the best evidence-backed method to get people off of drugs. Most major insurers have prior authorization requirements for MAT and limit coverage of these expensive medications. Patients can get oxycodone or morphine without a prior authorization, but a patient trying to obtain Suboxone to quit a heroin habit will encounter a number of roadblocks. Choosing to quit drug abuse is hard enough without having to fight your insurer for coverage. Substance use disorder is a disease and merits treatment as such. Treating substance use disorder properly with MAT reduces costs for both the health insurer and society at large. The system is set up to maintain addiction not treat it. Once more, a sick system not a health system.

To me, it seems that stigmas around certain conditions and prejudiced beliefs about those struggling with these conditions are involved. Some people feel those who are obese or who smoke or who abuse drugs are responsible for their own problems and lack self-control or willpower. They feel they deserve any consequences that result. I do not share this view. Everyone is equally worthy of respect and dignity, and, if someone is working to change for the better, they should be given a hand in a compassionate and open-minded manner.

Ultimately, I see the insurance reimbursement system as more of a sick system then a health system. It promotes the status quo rather than health change. It also reflects the same biases and prejudices that society as a whole fosters.

Wholesale reform to our system to focus on health and well-being is going to require a wholesale change to how we fund our health care. Single payer is one such a solution, though there may be others. A single-payer system would see reducing unhealthy behaviors as a way to reduce costs in the longer term. Another option is a system where health systems and doctors were paid per member to keep them healthy, as opposed not a fee-for-service model. There are multiple options for reform that would be useful, but, at the end of the day, the system we have is not working.

Heather Finlay-Morreale is a pediatrician.  This article originally appeared in Doximity’s Op-(m)ed.

Image credit: Shutterstock.com

Prev

Quality over quantity in life and care

September 23, 2018 Kevin 3
…
Next

The impaired interactivity of EHRs

September 23, 2018 Kevin 4
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Quality over quantity in life and care
Next Post >
The impaired interactivity of EHRs

More by Heather Finlay-Morreale, MD

  • Having more doctors to assess rare, multi-system illnesses

    Heather Finlay-Morreale, MD
  • Focusing on the frontlines of COVID leaves behind those with disabilities and chronic illness

    Heather Finlay-Morreale, MD
  • Religion and spirituality are in the exam room

    Heather Finlay-Morreale, MD

Related Posts

  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • How social media can help or hurt your health care career

    Health eCareers
  • Sharing mental health issues on social media

    Tarena Lofton
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • 3 ways to advance the credibility of online health information

    Robert Pearl, MD
  • Why this physician teaches health policy in medical school

    Kenneth Lin, MD

More in Policy

  • The realities of immigrant health care served hot from America’s melting pot

    Stella Cho
  • Healing the damaged nurse-physician dynamic

    Angel J. Mena, MD and Ali Morin, MSN, RN
  • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

    Mohammed Umer Waris, MD
  • Breaking down the barriers to effective bar-code medication administration

    Amy Dang Craft
  • The locums industry has a beef problem

    Aaron Morgenstein, MD
  • Canada’s health workers are sounding the alarm. We must act, now.

    Ivy Lynn Bourgeault, PhD
  • Most Popular

  • Past Week

    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

      Kevin Haselhorst, MD | Physician
    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 13 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Journal Shows Its Commitment to Exploring AI in Medicine
  • Do Away With 'Lockout' Period in iPLEDGE, FDA Advisors Urge
  • Cluster Headache, Migraine Linked to Circadian System
  • Smaller Liver Transplant Candidates Wait Longer, Less Likely to Receive Organ
  • A 'Double Whammy' for Gastric Cancer Risk

Meeting Coverage

  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Most Popular

  • Past Week

    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from a toxic relationship with medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

      Kevin Haselhorst, MD | Physician
    • The hidden truths of hospital life: What doctors wish you knew

      Emily Stanford, DO | Physician
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Our health system is a sick system
13 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...