Patient-driven rationing

PATIENT-DRIVEN RATIONING…. Best health care in the world.

In hindsight, maybe Jesse Ashlock shouldn’t have walked out of the New York emergency room last summer, only a couple hours after being knocked unconscious in a Brooklyn bicycle crash.

Medical crews told him he needed a blood test, chest X-rays and probably a CT scan to check for head injuries. And he certainly should have had treatment for major road rash, including raw scrapes on his face, neck and hands.

But the 31-year-old editor for a design magazine was between jobs, briefly without health insurance and afraid of being stuck with a sky-high hospital bill. The doctor on duty dismissed Ashlock’s questions about cost, telling him she was “a physician, not an accountant,” he said.

So Ashlock stalked out of Woodhull Hospital without treatment, becoming part of a small but growing number of patients turning down emergency care because they fear they can’t afford it.

In Ashlock’s case, he had to make a decision. On the one hand, he was afraid of the hospital bill. On the other hand, he was afraid to go to sleep, since if he had a concussion, he could slip into a coma. He decided the fear of the hospital bill was more intense, so he went home. (He’s fine.)

The MSNBC report is a little fuzzy on specifics, but said physicians are finding stories like this increasingly common. A growing number of patients are refusing certain treatments, tests, and exams, which they suspect will cost too much. It is, in effect, patient-driven rationing.

Dr. Sara L. Laskey, who who works in the emergency department of MetroHealth Medical Center in Cleveland, Ohio, told MSNBC about a woman with bronchitis and pneumonia with life-threatening oxygen levels. She refused treatment — even after Laskey tried to arrange for an oxygen kit to be sent to the woman’s home — because she didn’t have insurance.

“She refused, saying she would share her husband’s oxygen,” Laskey said. “Ultimately she left without the oxygen or an admission.”

When patients are more afraid of medical bills than life-threatening ailments, there’s a problem.