Contracting With Patients To Follow Prescribed Treatment
Contracting For Compliance , the post this Friday past at AlignMap, my professional blog and web site, deals with a West Virginia program that would provide certain healthcare benefits, in addition to those covered in a basic healthcare plan, to individuals covered by Medicaid if and only if they formally agreed (i.e., signed a contract) to follow prescribed treatment, including taking medications as directed, showing up for appointments, adhering to diets or exercise programs, etc. If those individuals were unwilling to enter into that agreement or if they proved unable to comply with treatment, that enhanced set of benefits would be eliminated.
While the focus is on the West Virginia program, two other states are considering a similar plan, and it’s said that the federal healthcare agencies are vigorously promoting the idea as well.
Also discussed is a Perspective published in The New England Journal of Medicine (NEJM), which points out some fundamental ethical and clinical flaws in this measure.
I take the position that the arguments currently advanced by West Virginia, the Feds, and the NEJM are clinically oversimplified and politically polarized, tainting and, deliberately or unintentionally, subverting a potentially beneficial concept.
From some of the email responses I’ve received to this post, it seems that it might be of interest to those outside the healthcare industry, including those who read the Heck Of A Guy blog. This is, after all, a matter of public policy determining how tax monies are used to provide healthcare to a portion of the population most in need. Even more significantly, if this project is viewed as a success, there is reason to think that other government-funded health plans and commercial health insurers would institute similar policies.
See what you think at
What is it about coercion that bureaucrats don’t understand?
If you look at old black and white pictures of Chicago, for instance, a school and a church/temple anchored the neighborhood. Think an eight block square. In some areas there were churches on almost every corner. These anchors were joined by a police station and fire station. A large chain grocery took over the original mom and pop stores, which were another integral part of the landscape, along with a dry cleaning place, shoe repair, etc. Oh, yes, there were local doctors. And they made housecalls.
The chains have fled the inner city, making healthy, fresh food difficult to access. Schools have closed. The doctors are holed up in the suburbs or hospitals. Probably the only good news is the attempt of law enforcement to establish a relationship with residents with beat cops who walk around getting to know people.
Basically food, medical, educational, and human services have to return to the neighborhoods. Medical facilities in particular need to de-centralize. Perhaps a local medical care building could be located next to a police or fire station. Which would make sense in the city or out in the country.
Hospitals need to have satellites in the neighborhoods so medicaid patients can see someone within WALKING distance. And I don’t mean a Doc in a Box. Perhaps public health nursing could mean something again. There is a real opportunity for nurses to staff these places. They tend to be more empathetic anyway, n’est-ce pas? Retired docs could be enlisted to help out if they haven’t all gone to Florida.
At the very least, there needs to be a hospital bus service for the neighborhood that takes people to their appointments. Either for FREE or at a reduced cost. You try using public transportation with a sick kid. A regular bus with a schedule, plus a van for emergencies.
It sounds like medicaid patients are being required to do all the heavy lifting. The more things change, they more they stay the same.
What do medicaid recipients get in return for their agreement to be compliant and all those other requirements? NOTHING.
Comment by Mrs. Linklater — August 28, 2006 @ 6:20 am