The problem with for-profit health care

for profit health careOr whose best interests are being served?

It’s no secret that our health care system is filled with conflicts of interest.

That’s because, for the most part, the doctors, hospitals and insurance companies that are the framework of the system are for-profit businesses. Like any other for-profit industry, health care sells a product and encourages you (or your insurance company) to buy it.

A friend of mine had a recent experience with for-profit health care that she wanted to share:

In my opinion, anyone who has been told they “must” replace their orthotic inserts every year or every few years has been sold a bill of goods.

Why do I think that? I’ve always had bad feet. ‘Weak ankles,’ my pediatrician grimly told my mother just before I started school. I didn’t know it yet, but I was an over-pronator, or someone whose foot rolls inward more than normal. I had to wear corrective shoes, which attracted some unwanted attention on the playground and failed to resolve the problem.

Decades later I developed plantar fasciitis. I met with a foot doctor who told me my options and advised orthotics, given my foot structure. They were custom made and very expensive, but were covered by my health insurance. Soon my plantar fasciitis was gone.

I liked that foot doctor, but for some reason I decided to check out another doctor. Maybe because he had a swanky practice that put athletes and ballerinas back in business after their injuries.

He also was part owner in a shoe store, which should have been a red flag from day one.

Because my orthotics only fit in my athletic shoes, he told me to purchase “dress” orthotics that would fit into my dress shoes. Again, my insurance covered these devices, they fit into most shoes, and the original orthotics were helping, so I went along.

Then I injured my ankle. I spent time in a boot and an ankle brace, and did some physical therapy. This second doctor started padding my original orthotics to relieve pressure on my foot. At my most recent appointment, he said my original athletic orthotics needed replacing although they were only about four years old. But I had already maxed out my insurance benefit for orthotics, so the replacements would cost me hundreds of dollars.

I questioned his opinion and didn’t order the new orthotics. I wanted a second opinion and made an appointment with my first foot doctor (who, in hindsight, I never should have left). He confirmed what I suspected—my original orthotics were just fine. In fact, he admitted he’d had his own for over 15 years!

He also looked askance at the extra padding on my orthotics. Did the orthotics work without the pads? Yes. He removed the pads and my feet have been fine ever since.

I think I’m right in assuming the second doctor, the one with the shoe store, only recommended the “dress” orthotics as well as the new athletic orthotics because it would mean more profit for him. I didn’t need them. Perhaps if my insurance had paid for the new orthotics I would have blindly gone along. But because I had to pay for them out-of-pocket, I was much more conscious of the cost and asked questions.

Be wary of “attached” services

I agree with my friend that the second doctor pushed for the new orthotics because, frankly, he would make more money. It is just one example of what is happening every day at every level of health care.

Nowhere is the profit-generating machine more obvious than in the doctors’ offices and clinics with attached orthotic labs, pharmacies, optical departments, laboratories, imaging centers, physical therapy clinics and even gift shops and coffee bars.

These shrewdly-positioned services are touted as being for the patients’ convenience. Right.

They actually serve two purposes. One, they make the business more attractive to the consumer, or more “swanky” as my friend put it, and more customers is always good business. Two, they generate a lot of extra income.

Once the services are available, it is in the health care providers’ best interests to sell as much of the product as possible. But although these adjuvant pharmacies or labs are more convenient, they often cost more. And when conflict of interests exists, there is always the nagging doubt whether you needed the product or the service in the first place.

That’s one of the reasons I have reservations about CVS, Walgreens and other drugstores getting into the business of providing primary care.

As I have posted about many times on this blog, the burden is on you, the patient, to take control of your health care. Ask questions, get second opinions and comparison shop, as much as you are able, for the best price.

Related posts:

Perhaps convenience is more important to you than cost. Or you have good insurance with a low deductible so your out-of-pocket costs will be small.

But it’s still in your best interests to think for a moment about the expense. The more money an insurance company spends on claims, the higher your premiums, copays and deductibles will rise in the future.


Frugal Nurse


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