There are many catch-22’s in the health care system. A managed care company reimburses providers and hospitals for services rendered to beneficiaries at a certain payment level. The payment is just enough for hospitals and providers to maintain a contractual relationship with the managed care company and just enough for the insurance company to expense the least possible reimbursement to maximize profits. This reimbursement amount is a major factor in maintaining a large and stable network of providers that beneficiaries can choose from and can easily obtain care. The catch? Only if the payment is enough!
Access to health care is important. If you were taught under the same school of thought, the Five A’s of ACCESS are affordability, availability, accessibility, accommodation, and acceptability.
Affordability
Are you willing to pay what the provider is willing to accept or is the provider willing to accept to what you are willing to pay? Even if people were to pay by means, most people could not instantly pay off a health care bill. Perhaps a person may be able to pay over a long period of time like they do with their monthly mortgage and car payments, but since most people do not physically see their health care value like they do with their car everyday, most of these bills may end up at the collection agency. Thus affordability often equates to whether or not a person is insured and can afford to pay insurance premiums to the insurance company that really pays what the provider is willing to accept.
Availability
Can you see your physician immediately or do you have to wait 3 months to a year in order to get in for your annual exam? Does the physician have adequate and up-to-date technology and knowledge to perform his or her duties? Does the practice employ enough practitioners and personnel to have an efficient and smooth visit?
Accessibility
Are they local and easy to get to? Or is the next closest doctor more than an hour away?
Accommodation
Are the providers available when you need them? Do they have appointments available beyond regular business weekday hours and weekends? Optometrists and dentists tend to offer more available hours than general practitioners. Does you doctor make night calls like France’s SOS Médécins. San Francisco’s On Call Medical Group, albeit expensive, does make urgent individual night calls, which can circumvent an unproductive long wait at the emergency room.
Acceptability
Do the providers openly accept you the way you are without passing judgment? Oftentimes providers presume they know best for the patient not only for medical advice but for your social and economic welfare.
In the movie Juno, the ultra sound imaging technician lauds Juno, the pregnant teenager, for putting her child up for adoption because the technician has seen too many cases of disturbing teenage mothers raising children in the worst possible way. Well who is to say that the adoptee’s parents would be better suited? The presumptuous technician then received a mouthful from Juno’s step mom.
Other factors include age, gender, social class, and ethnicity of the provider in the eyes of the client and of the client in the eyes of the provider.
So consider how accessible your provider is and shop around for the provider that best suits you and vice versa.
