How can the health of patients coexist with patient autonomy?

Managing diabetes is all about control: controlling what you eat, when you eat, and the amount of insulin you give yourself. As someone with type 1 diabetes, I understand how control over one’s blood glucose levels is vital to maintaining a healthy lifestyle. When I was hospitalized due to a car accident, however, I saw how the hospital’s desire to control my care ended up costing my insurance company more than what seemed appropriate.

I had been hospitalized due to a car accident that had been caused by low blood sugar (hypoglycemia). The nursing staff would come into my room three to four times every day to check my glucose levels for the three to four days I was hospitalized. I had my glucose meter with me and explained to the staff that I could take my levels myself. I had been a diabetic for over twenty years, and I have a clinical background in nursing. Despite my experience, the nursing staff explained that it was not a bother and that they would take my glucose levels. I thought, “If this is hospital procedure, what could be the harm?”

After I was discharged, I looked over the multi-page bill. I noticed that I had been charged something like $40 for each glucose level the nursing staff took for me. Over the course of my hospital stay, these charges added up to an exorbitant amount. I called the hospital billing department for further explanation. If each glucose strip costs me about one dollar and the lancet maybe a few more cents, how in the world could they charge me $40? The billing department told me that was how much they charged, simple as that. They told me that the cost included a nurse doing the finger sticks and glucose levels. I explained to them that, being a nurse myself, these charges were ridiculous. Millions of patients know how to take a finger stick; was a hospital nurse really required? How could it cost nearly $40 for a nurse to spend about a minute checking my glucose levels? I told the hospital that I would call my insurance company to explain the situation and advise them not to pay. I did call my insurance, but I do not know if they ever paid or subtracted those charges from the bill.

How can a hospital’s desire to control the health of its patients coexist with patient autonomy? Medical practitioners have to trust that their patients will take responsibility for their own health and well-being outside the walls of their practices. Why should that change when a patient is in the hospital? I also wondered how much responsibility the hospital had for the expense for glucose testing. What other factors, institutions, and regulations contributed to the high cost? Did the hospital set these rates in response to rising costs in health care as a whole? What responsibility do hospitals have to keep costs low? If providing the best care possible is the end goal, how much consideration should be paid to the expense that this care costs? As a patient, former clinician, and current health policy and reimbursement professional, I understand that a variety of factors contribute to the high cost of health care. I cannot help but wonder, though, that if patients were given a little more credit for what they know about their own care, would we as a nation be able to lower costs?

Eric Mandelbaum is a contestant, Costs of Care essay contest.


This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

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