Iatrogenic stress, health-insurance variant

What’s the health impact of making patients worry about huge medical bills?

Iatrogenic disease &#8212 disease that results from the treatment process itself &#8212 is a major problem for health care, and one goal of any health-care system should be to limit the extent of such disease. But of course worry about money is a major stressor, so plans that call for, or threaten, substantial out-of-pocket expense do medical as well as financial damage.

A reader writes:

My wife was diagnosed Stage IV Ovarian Cancer (precisely, Primary Peritoneal Cancer) three years ago. Her five-year survival prognosis is around 18%.

We have an $2000 bill hanging over our head right now for a PET scan that the doctor ordered, but the insurance company now deems inappropriate for the circumstance.

I doubt there’s an individual out to get us (there is in fact an ombudsman who calls us every few weeks to find out how we are treated), but it boggles my mind that for any number of other

cancers/circumstances a PET Scan is a reasonable go-to diagnostic tool but for ovarian cancer this is completely inappropriate. $2,000 is a lot to us and really very little to the insurance company. While $2,000 may be a relatively small one-time cost, this is just one more bill

among many that we’ve accumulated over the past three years.

Now, I hate to admit this, but it may be (according to the insurance company) that treating my wife is no longer cost-effective. She’s now on a 5th-line therapy. But you’d think that, whatever sort of albatross my wife is around the insurer’s neck neck, that cost can be amortized across all the other healthy individuals they cover. And maybe &#8212 just maybe &#8212 the latest treatm will work, or at least allow my wife to see my daughter through her freshman year in college.

Who knows if we will end up having to fork over the $2000? If another PET scan is imperative, will this same provider now see us as a (payment) risk and deny service?

As I’m sure you know, getting sick kind of sucks. I have no idea how my wife would fare under any other healthcare system. I do know, however, that this system is providing plenty of stress over-and-above the stress of a cancer diagnosis and treatment.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com