Wednesday, February 18, 2009

Health Care and Do-It-Yourself Diagnosis

In the parlance of the health care industry, according to the New York Times, Plenty of uninsured adults are among the “young invincibles” — people in their 20s who shun insurance either because their age makes them feel invulnerable or because expensive policies are out of reach. Young adults are the nation’s largest group of uninsured — there were 13.2 million of them nationally in 2007, or 29%, according to the latest figures from the Commonwealth Fund, a nonprofit research group in New York. They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones. When emergencies strike, they rarely can afford the bills that follow.

According to National Public Radio (NPR), on a typical day, about eight million people type "back pain," "migraine," or some other medical symptom into a search engine. Increasingly, the Web is the first stop for health-related information. Guests talk about so-called "cyber-chondriacs" and how the Internet has changed doctor-patient dynamics. The Internet is changing not just the way patients get medical information, but the way they interact with doctors, their families, and even with strangers. A new report from the Pew Internet & American Life Project gives a glimpse of some of that change. It studies people with disabilities and chronic conditions, who are some of the most avid users of Internet health sites. Fewer of them go online than the overall population, probably because many are elderly, a group that is still less likely to use the Internet. But when people with disabilities and chronic conditions do use the Internet, they are more likely than other users to look up health information and use that knowledge to question a doctor, manage pain or change the way they cope with a chronic condition. Overall, the Internet is making health care better.

According to the NY Times, Internet diagnoses, self-medicating and trading prescriptions, of course, come with potentially dangerous side effects. Most family insurance policies cut off dependents when they turn 19 or finish college, and many young adults start out in New York cobbling together part-time or freelance work with no benefits. Many uninsured young people have taken the wrong antibiotics borrowed from friends. People with urinary tract infections are taking meds better suited for ear infections or pneumonia — the problem is, they haven’t really treated their illness, and they’re breeding resistance. Or they take pain medicine that masks the symptoms. And this allows the underlying problem to get worse and worse.

According to the Commonwealth Fund, almost two of five (38%) high school graduates who do not enroll in college and one-third of college graduates are uninsured for a time during the first year after graduation. Several states have passed laws to expand coverage of dependents up to age 24 or 25 under parents' insurance policies. This policy change, in addition to two others—extending eligibility for public insurance programs beyond age 18 and ensuring that colleges require and offer coverage to full- and part-time students to have coverage—could help uninsured young adults gain coverage and prevent others from losing it. About 60 percent of employers who offer coverage do not cover dependent young adults over 18 or 19 if they are not full-time students. Young adults from low-income families are especially at risk: half (48%) of 19-29 year-olds living in households under the poverty level are uninsured. Two-thirds (66%) of young adults without insurance report missing needed care or treatment and/or having problems paying medical bills. About half (49%) of uninsured young adults report being unable to pay medical bills, being contacted by a collection agency, or significantly changing their way of life to pay medical bills, compared to one-quarter (25%) of insured 19-29 year-olds. Over half (56%) of uninsured young adults did not see a doctor when they were sick, did not fill a prescription, or skipped a recommended test, treatment, or follow-up because of cost, vs. to one-third (33%) of insured young adults. Young adults with a time uninsured in the past year faced bill and access problems at rates similar to those who were uninsured all year.

According to, consumers are using the Net to educate themselves and shake up the medical establishment's Marcus Welby-era doctor-knows-best mentality. Now they're starting to control their own medical spending, especially those with high deductible plans, HSAs, and flexible spending accounts. Thanks to health savings accounts, people are moving over to "consumer-directed health plans" - you, the patient, get a health-care budget from your employer and manage your expenses accordingly. That means you'd better shop around before opting for a $2,000 MRI. Free to buy health care like anything else, tech-savvy consumers are looking at the next generation of medical services, everything from online genetic testing to Wal-Mart medical clinics. But as always, the real opportunity lies with services not yet invented. How about a Priceline for nonemergency surgery? Or an online reservation system for doctors' appointments, à la Open Table? Here are some options for seeking personal health care:
1.) The Gene Screen: Online genetic-testing services are springing up to take advantage of advances in genomics - and the growing willingness of consumers to conduct their most personal business over the Internet.
2.) Retail Therapy: More people are adding health care to their shopping lists as walk-in medical clinics are popping up in Wal-Marts, drugstores, and other retail outlets.
3.) A Second Opinion for Medical Bills: As the number of people paying for medical treatment through health savings accounts soars, software services that help them manage bills and spot errors are on the rise.
4.) Home is Where the Health Care Is: The market for home medical monitoring for chronic conditions is taking off thanks to new interactive devices that remotely track patients at home.

Health care can be done with or without insurance. The coverage helps to take the sting out of the bill, but treatment is available if you need it. Doing your own medical treatment is not a wise idea, and you should always visit a primary physician or clinic if you have symptoms that cannot be treated with over the counter medications. Do-it-yourself health care is not a wise choice when your personal health is on the line. Options are available in many channels, so don't go it alone.

Until next time. Let me know what you think.

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