Healthcare Insurance Versus Actual Healthcare

One of the perpetually frustrating things about our healthcare debate is that it’s largely a healthcare insurance debate. There is little direct discussion of how various proposed systems would deliver actual healthcare. A good healthcare system, of course, would be accessible to all, regardless of income. But it also would provide appropriate healthcare to those who need it. Which bring us to this NY Times article about readers’ frustrations with the treatment of their urinary tract infections (UTIs; boldface mine):

The rise of drug-resistant urinary tract infections has been particularly burdensome for the significant subset of people who suffer from them on a regular, recurrent basis. These individuals, mostly women, can wind up on a carousel of antibiotics, sometimes the wrong ones, and many experiment with homeopathic alternatives that have not been scientifically validated…

The rise of drug resistance in the germs that cause U.T.I.s does not mean that these infections are untreatable. Rather, it leads to higher hospitalization rates and complications. It also creates a societal risk because overall resistance can grow when antibiotics are overused, for example when someone with a U.T.I. is prescribed the wrong medication and has to take more than one course of antibiotics.

This has intensified a debate over whether to regularly encourage doctors to culture a patient’s urine to determine which germ is causing the infection, and which drug can best treat it

Doctors and researchers interviewed agreed that in an ideal world, it would be great to culture each infection for possible infection. But that is far from realistic because cultures cost money and take time, discouraging doctors, labs and insurance providers, and also because the usual practice is to quickly treat urinary tract infections with antibiotics.

Dr. Eva Raphael, a physician at San Francisco General Hospital who does research on U.T.I.s, said cultures should be taken more often. “Yes, it takes manpower to send a urine culture, plate it, identify the colonies,” she said, but she added that she believes it’s worth doing “if we’re going to be judicious about the use of antibiotics.”

It might hearten some readers to know that the rise in resistance has spurred policymakers to think about whether to make getting cultures more standard. Dr. Drekonja, who is involved in discussing those kinds of issues with the Infectious Disease Society of America, said: “I suspect it will be addressed in the next version of U.T.I. guidelines,” although it is not clear when those will come out or what they will say.

A national system would allow us to implement standard treatments countrywide (if there are disparities in UTI treatment, who do you think is getting screwed?). It also would allow us to determine what treatments work best (and for whom). Patient data should not be trapped in disparate electronic health record systems that are impossible to pull data from. I really don’t care what the behind-the-scenes mechanism for funding healthcare is, but we need a national system that, among other things, standardizes treatment and improves outcomes–which is to say, heals sick people.

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1 Response to Healthcare Insurance Versus Actual Healthcare

  1. Zachary Smith says:

    ^^^ One of the perpetually frustrating things about our healthcare debate is that it’s largely a healthcare insurance debate. ^^^

    Amen to that. The Elites work hard to keep us focused on “insurance” rather than getting good medical treatment.

    Regarding the resistance to “culture each infection”, a person has to ask if this is simple stupidity, or does somebody have a monetary motive. If that lab culture costs X dollars and the treatment for an advanced infection costs X times 100, skipping on them would make sense if somebody benefits from the “X times 100” business. The logical villain here would be the Corporate Medical Centers.

    I’ve recently come to the conclusion that my Big Health Care System is ok if I recover from whatever was ailing me. But their bottom line is far more important than the incidental effect of me getting well quickly. Ok, I’m paranoid, but how else to explain why the “cultures” aren’t done more routinely.

    This is a sensitive subject with me, for quite recently I attended the wake of a relative who collapsed and shortly afterwards died with a whole-body infection. How Did Her Doctors Miss This?

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