One Reason Our Healthcare Costs Are Increasing

One industry that lean is starting to penetrate is the health care industry.  After experiencing a story of a relative last week, it made me sick to hear how insurance companies don’t help the situation of increasing cost.

The person is on a medication that is extremely hard to get approved for by the insurance companies.  Approval from the insurance companies is a must because most people can’t afford the medication without it.

A few years back the person was approved for the medication after a 4 month process.  When they started the medication the expectation was they would be on it for at least 15 years or so.  It basically is part of their life at that point.

Fast forward to present day.  The person has responded incredibly well to the medication.  In fact, they responded so well, there is thought that the person may not have to take it anymore, but the doctors can’t take the patient off of the medication because if they do and the patient does need the medication the doctors will not be able to get the patient approved a second time.  At least it has never happened yet.

Because of the pain and inflexibility of the insurance companies, the patient and the doctors are in a tight spot.  Do they keep the patient on the medication even though they may not need it or do they go a few months without the medication but still filling the prescriptions and holding on to the medication so the patient doesn’t loss eligibility?

Either way, it is money out of the patient’s pocket that could be saved.  Plus, additional cost to the insurance company of a VERY expensive medication.  In either of these cases, more costs will be added causing insurance premiums, medications, the whole health care system to increase.

This just isn’t right.  The system has made it nearly impossible to do the right thing and extremely easy to do the wrong thing.  As a country, we have a long way to go to fix some deep rooted issues with our health care system, which I believe is still one of the best in the world.

Posted on April 18, 2011, in Customer Focus, Health Care, Metrics and tagged , , , , , . Bookmark the permalink. 3 Comments.

  1. I also think of the human cost – why should it take four months for the approval? The patient was either sick for that amount of time, or paying for the medication directly. Either way, unnecessary suffering for the patient and family.

    • Karen you nailed it about the approval. In this case, the pharmacy did the right thing and sent the patient 2 months of medicine at no cost believing the patient would be approved. That was incredible to see and shows much the health care industry does care about the patients. Sometimes I think people lose sight of that because of the red tape that can get in the way.

  2. Good to see you touching on healthcare, Matt. Having been working to apply lean thinking in healthcare for almost 5 years now, you’d be amazed at the opportunities to improve it – all through the healhcare spectrum – but especially directly with patient care. As you’ve seen with manufacturing, it’s equally hard to change a culture in healthcare, but couple of advantages I think healthcare has over manufacturing is the direct contact with patients (customers) and the intrinsic nature of people in healthcare to make peoples’ lives better, with less of an emphasis on profit (at least for not for profit hospitals). Nevertheless we still have a long way to go.

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