Healthcare's tedious work is also dangerous

The U.S. healthcare system is one of extremes, in which the same patient on the same day can experience herculean efforts to return to health while being denied a $12 medication, according to one physician's op-ed in The New York Times

Chavi Eve Karkowsky, MD, is a maternal-fetal medicine physician working in New York City. In her piece, she details care episodes in which patients presented with urgent, acute medical problems after medications were prescribed but not taken due to administrative barriers, or "work that is almost always boring but sometimes causes tremendous and unnecessary human suffering." 

For instance, one pregnant woman was prescribed antibiotics for a urinary tract infection that the pharmacy did not fill due to an insurance or medical record problem. The physician's office was closed over the weekend, so the patient tried to treat her condition via water and cranberry juice. By day four, she was in the obstetric triage unit with pyelonephritis and a 12-person care team urgently working to keep her and her baby safe, resulting in hospitalization for several days. 

"This patient's story is a result of the space between the care that providers want to give and the care that the patient actually receives. That space is full of barriers — tasks, paperwork, bureaucracy. Each is a point where someone can say no," Dr. Karkowsky wrote. "This can be called the administrative burden of health care."

The unpaid labor required to navigate administrative burdens to receive medical care — lining up referrals, taking time off of work for appointments with lengthy wait times, waiting in the emergency room, sorting out medical bills, checking on prescription refills — is intensifying, due in part to more stringent protocols by insurance companies in effort to manage costs of care. 

As one health economist said, pushing up the amount of time — not necessarily the amount of dollars — is an effective way of deterring costs. A 2021 study found about 24 percent of insured adults reported their care was delayed or missed entirely because of administrative tasks.

"One of the first steps to any comprehensive solution would be a true accounting of the costs of administrative burden," Dr. Karkowsky wrote. "Maybe we in the medical system do have to start counting up the hours patients and providers spend on the phone, in waiting rooms and filling out forms. That would be difficult: It's not a metric the health care industry is used to evaluating. But it's not harder than doing the work itself, as patients do."

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