Surviving US Healthcare: Navigating a Tense, Complex System
TL/DR –
Navigating the healthcare system is becoming increasingly complex for patients, particularly those with serious or chronic illnesses, due to an array of challenges such as coordinating doctor appointments, dealing with insurance complications, and keeping up with medication needs. The gaps in patient care are exacerbated by a lack of communication, doctor and drug shortages, and frequent insurance complications. While some care providers and employers are now beginning to offer navigation assistance to help guide patients through these complexities, these services are not yet widespread and have limitations, further burdening patients who are already struggling with their health.
Tamika Davis, a colon cancer patient, struggled to navigate the healthcare system
During her colon cancer treatment, Tamika Davis lived in constant worry about her toddlers interfering with her chemotherapy treatment. Davis had difficulty finding reliable child care, and was left with many gaps in assistance as she couldn’t afford it and didn’t know where to source it. She expressed that she lacked the energy and strength to navigate the healthcare system alone.
Complexities in healthcare system add to patients’ burdens
Researchers and experts in care delivery reveal that patients are not getting sufficient help to manage an increasingly complex healthcare system. From insurance complications to shortages in doctors and drugs, the life of a patient with a chronic illness or serious disease is becoming more challenging. Elisabeth Schuler, founder and president of Patient Navigator, a company offering assistance in navigating the healthcare system, emphasized that accessing needed care is becoming more difficult. Although some care providers and employers are now offering help, and the federal Medicare program has started to cover these services, the assistance available has its limitations.
Multiple challenges faced by patients with chronic illnesses
Patients like Davis have to navigate a plethora of hurdles, such as coordinating doctor appointments and tests while simultaneously undergoing treatment or working. They also deal with coverage denials, care delays due to insurer pre-approval requirements, and difficulty in procuring medication if certain drugs are in shortage(source). Furthermore, they often need to act as intermediaries between doctors and specialists and struggle with paying medical bills(source), along with securing assistance for rent or utilities.
Navigating the healthcare system: A complex task
The problem is exacerbated for patients who don’t speak English or lack experience with the healthcare system, according to Gladys Arias from the American Cancer Society Cancer Action Network. Ali DiGiacomo, a 30-year-old personal trainer living with rheumatoid arthritis, highlighted the struggle of dealing with insurance companies while managing her health. She spoke about the constant changes in her list of covered drugs, leading to a delay in her medication schedule. She also mentioned the increase in care delays due to insurer pre-approval requirements and the challenges of getting coverage outside their network of doctors and hospitals.
Insufficient Patient Assistance and the Need for Systematic Change
Despite the existence of patient navigators in many cancer centers who help coordinate appointments, resolve coverage issues, and provide other support, access to these services is not widespread(source). Sam Fazio of the non-profit Alzheimer’s Association pointed out that Alzheimer’s disease patients and their caregivers often lack regular access to such help. Dr. Victor Montori, a Mayo Clinic researcher studying care delivery, stressed that for the system to better serve patients, a significant change is necessary. This could mean streamlining procedures, making appointments more flexible, and granting patients more time with doctors to reduce the burden on patients.
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