I was surprised a few weeks ago when I was told by one of my surgical patients that she was required to pay her co-payment for her surgery ahead of the procedure. I was confused because I, as her provider, wasn’t allowed to do that and I didn’t know how the hospital would know how much of the co-payment to charge since the procedure hadn’t taken place yet. However given the growing level of financial responsibility patients must bear for hospital care, it’s not surprising that hospitals are working to get ahead of the problem. Methods used by hospitals vary, though the goal—collecting as much as possible—is the same. The most aggressive hospitals are asking for as much as 70% of the amount due ahead of time. Others are merely calling ahead to patients and letting them know what kind of bill they can expect, while walking them through options that might help pay the bill. Regardless, the goal is to chase money ahead of time rather than after-the-fact.

•      Hospitals are, as I pointed out with my patient as an example, increasingly asking patients to prepay for medical procedures or shell out before they’re discharged, fearful of being left on the hook for large deductibles.
• Hospitals have good reason to be concerned about unpaid bills. Silver and bronze plans available on the state health insurance exchanges may come with
• deductibles as high as $5,000 or more and 41% of employer based plans have deductibles of $1,000 or more.
•    Attempting to help hospitals cope with this dilemma, the Healthcare Financial Management Association released guidelines last year. These best practices call for open and early communication, sharing clear information and finding resolutions fair to both patients and healthcare organizations. This is also what is seen in private practices. With the high deductibles either patients don’t go in for their annual physicals or convert to concierge practices or convert to cash base practices. What a wonderful situation where the goal or idea was to get all patients to utilize preventive care, primary care and therefore lower the cost of healthcare.

That being said, it’s hard to tell how effective such practices will be. After all, while a hospital financial counselor may be able to get an indigent patient into

Medicaid or help them qualify for charity programs, they can’t produce money patient simply don’t have. Some argue that this is the reality of high deductible

plans and that those plans were always about shifting the cost to the providers.

Payers talked a good game about high-deductible plans, which they claimed would put financial power in consumer’s hands and encourage quality care. But

research by the RAND Corp. has demonstrated that high deductible plans can encourage patients to put off needed care. Remember a cancer patient of mine that I met in the YMCA, telling me that he couldn’t afford to see me for follow-up care due to his high insurance deductible of $5,000. “All” his healthcare was out of pocket expenses.

The big question, in situations like this, what happens to the patient who needs a surgical procedure, chemotherapy or radiation therapy, but can’t pay the deductible that the hospital demands? Are they denied their procedure or their chemotherapy or radiation therapy?

Hospitals dealing with patients facing such burdens may end up eating a lot of the cost regardless of what strategy they use. Is it time to kill the high-deductible plan and find other ways to cut premium costs?

Let us see what other universal or affordable health care systems do for sustainability. The strategies that are left to pay for all to be covered includes the use of higher income taxes, upwards of 64%, value added taxes, now as high as 27%, or a combination or both as well as limitations on coverage, long waiting times for procedures, appointments to see their physicians or more likely, the physician extenders.

I’m not sure where the liberal minded people of this country think that the money will come to pay for a top-level healthcare system, if a significant part of the population doesn’t pay into the system, especially with our national debt approaching $18 trillion. That is 47% or more don’t pay taxes and or don’t pay for their healthcare coverage. The liberals believe that the rest of the population is responsible for financing the health care system. But how much will the taxpaying or premium paying part of our population be able to support those that don’t want to contribute?

If you keep penalizing the workers for working hard there is a dis-incentivizing of entrepreneurs, business owners and the workers of top production models, which we have prided ourselves as Americans. Are we seeing a change in the American work ethic paradigm? This is worrisome!

Let’s next discuss Wellness Care instead of Sick Care and how to modify our present system to one that will benefit us all.