Costly, inefficient system the real problem

Your Health's "Second Opinion" section on Jan. 4 was narrow in its view of what the driving forces are that make today's health-care system overwhelming. It is not, as readers suggested, managed care giving doctors less time to spend with patients combined with patients having too much information because of the Internet.

		About this package In today's Health Forum, we are including letters received in response to our Second Opinions package of Jan. 4, which featured readers' advice and suggestions for getting and giving better health care.

Based on our experience at the Consumer Health Coalition, located in Downtown Pittsburgh, the major issues are lack of affordable health coverage, lack of information on how to use the public programs that are available and a system that is set up to keep people out rather than to serve their health-care needs. All of these problems are part of a dysfunctional system that is expensive, inefficient and not cost-effective -- and that keeps getting worse.

Yes, consumers need to be self-advocates when they get to the doctor's office, as readers suggested, but we need strong consumer voices and input at all levels to build a system focused on quality care for everyone in an efficient, cost-effective and streamlined manner.

The coalition hears stories every day from people who need health care for themselves and their family members: people who work at jobs with no health insurance, older people too young to qualify for Medicare who can't work anymore due to chronic illness, people with mental illness and parents seeking coverage for children and elderly people who can't afford prescription drugs. Our organization screens for eligibility and helps people apply for government funded programs including the Children's Health Insurance Program, adultBasic, Medical Assistance for Workers with Disabilities and Medicare Buy-In.

When a caller doesn't fit the guidelines for programs -- or, as in the case of adultBasic, are put on a waiting list of more than 100,000 -- he is given suggested sources of sliding fee clinics, free and low-cost dental, eye and prescription assistance. If a caller has a problem enrolling, we collaborate with the PA Health Law Project, which helps those who have been denied but believe they are eligible for coverage.

Individuals who contact us are encouraged to join in collective advocacy as their stories are important for policymakers to hear. We are a growing movement of consumers whose voices will no longer be left out of the system. Within our coalition, our Disability Advocacy Committee and Aging Advocacy Committee have won important policy gains in improving access to care. Our member organizations and individual consumers find that with a collective voice we can influence policymakers to work toward changing the health care system. We believe it can and should be expanded to include all Pennsylvanians with difficulty obtaining and using health services.

Ten percent of our population lacking health-care coverage is a crisis for our region that we can't afford to ignore.

KATE ROBINSON

Kate Robinson is the executive director of the Consumer Health Coalition, Downtown.

---

Lend the hospital staff a helping hand

This is in response to the article "Set your own rules for hospital care," by Frank Parillo in Your Health, Jan. 4.

I have been a nurse in the spinal cord rehabilitation for seven years, and these are suggestions that also need to be mentioned.

If you stay with the patient, help with the care -- washing, changing, feeding. This would free up a hospital employee to help someone who has no one.

Know your medications, but realize that there may be a slight difference in times that they're administered. When you are waiting for medications, please realize that multiple patients also are waiting.

Ask questions, but be polite. Do not be hostile to the nurses or aides. We are there to help.

All must wash hands, and that includes visitors. Doctors, nurses and aides have access to multiple areas and wash stations that visitors do not. Hand washing is important to prevent the spread of bacteria.

If you are ill, do not come to the hospital to visit. Also, do not bring children to the hospital. It is full of germs, and children may not have the resistance to bacteria.

Please realize that all hospital personnel are there to help. We are certainly not doing it for glamor or for getting rich.

Say "thank you" once in a while with a smile. It helps hospital personnel to know they are appreciated.

Kathleen Larkin, R.N.
UPMC Rehabilitation Hospital, Squirrel Hill

---

Not putting up with rude doctors

Why do some people change doctors? I, for one, do not wish to have my Medicare coverage paid to a doctor who gives poor personal care. Here are some examples I recently have encountered:

My gynecologist retired, selling his practice. I made my yearly appointment with the new doctor. At the visit, I was prepared by the nurses for my annual pelvic exam (lying on the table) when the new doctor walked in and said, "What the hell are you doing here?"

I almost fell off the table in shock, but managed to say, "For my yearly exam.''

I never returned and found a new gynecologist, but . . .

Upon my first visit, I was again prepared for the exam and the doctor came in. No hello, no nothing. He examined me and said to get dressed and come to his office. When I reached his office, he again said nothing and simply wrote a prescription for hormone replacement. That's it.

I changed doctors again.

The one I have now talks to me and asks me about my health.

On an visit to a local hospital, I again encountered a rude doctor. When he came to discharge me, he told me to come see him in two weeks. I told him politely that I would not because he didn't know how to treat a human being.

I refuse to allow my Medicare coverage to be paid to insensitive doctors. I've changed doctors so often that I wrote out and photocopied a complete medical history on myself. I hand that to receptionists when I visit new doctors for the first time, and they appreciate it. It saves time, and I don't have to sit in the waiting room and try to remember my past medical conditions.

Marian Pencheff
Lincoln Place

---

A few tips to cut your drug store wait

Time is something that no one has enough of these days. And waiting in line for anything adds to this problem. The following tips can help you minimize your "wait time" on your next visit to the local pharmacy.

Call in refills a day or two before you plan to pick them up. A busy pharmacy fills prescriptions in the order in which they are received. If you simply walk in saying that you need something refilled, you may be waiting behind 10 other customers, or perhaps someone who was just discharged from the hospital with a whole slew of prescriptions. If you phone ahead, we can fit them in when we get a spare moment, and they'll always be ready when you arrive.

Second, if the pharmacy is out of or running low on your medication, it can be ordered for the next day. This will save you from having to make two trips. (Most insurance plans don't allow extremely early refills, but all give you a few days' leeway.)

Be sure that your prescription has refills. Even if you are taking a maintenance medication indefinitely, we can't refill it if there aren't any left. (The label on your bottle lists remaining refills.) Call your physician's office to let it know that you are out of refills. Staff can then check your chart and call us.

Since physician's offices are very busy give them at least a few hours to handle your request.

If your doctor gives you a new prescription, ask if it can be phoned to your pharmacy. If you have some other errands, do those first and then go to pick it up. However, if you are sick and need it immediately, have the doctor's office mention that. You also can ask your pharmacy to deliver it to your home; many will do so for free.

Make sure that your pharmacy has your current insurance information. Since insurance plans are always changing, sometimes without you even knowing, always carry your insurance card.

Following these tips may not eliminate your wait completely, but will definitely give you some extra time for on yourself!

Laura Romeo
Rosslyn Farms
Pharmacist

---

How employers can reduce health costs

Many employers offer employee health care benefits, but look for ways to reduce the expense of providing them.

What employers haven't tried until very recently is motivating employees to take the best care that they can of their own health, and providing resources at the work site that will help them to do so. People who are in good health use fewer health care resources, thereby slowing the increases in costs.

These health promotion programs represent a fundamental change in philosophy. The return is proving to be as much as $3 on every $1 an employer invests in health promotion.

UPMC Health Plan and the University of Pittsburgh Medical Center recently instituted "MyHealth" to UPMC's 25,000 employees who are also members of the Health Plan. The MyHealth programs are voluntary and begin with a confidential, online personal health questionnaire. Upon its completion, an evaluation of the employee's health status is immediately available, as well as feedback about lifestyle or behavior changes that could improve the employee's health. If successful, the program will be offered to employer groups that offer our health benefits. Some employers may choose to include voluntary workplace screenings, where data such as height, weight and blood pressure are recorded. These screenings provide immediate results and allow for possible early intervention.

Healthier employees are more productive, have lower rates of absenteeism and incur fewer health care costs as well as enjoy a better quality of life. This movement has great potential to effect a positive change in the direction of healthier lives and steadier health care costs.

Sandra E. McAnallen
Vice president,
Clinical Services and Network Performance,
UPMC Health Plan