Grandma & Grandpa's Farm

Wednesday, June 4, 2008

Always Room for Improvement - Healthcare

Your Medicine is Covered... Except That One...

I guess when things are actually pretty good a person still looks at ways it could be improved. Now not every person in British Columbia enjoys the benefit of having their medical prescriptions included in their MSP but if you are low income or disabled or have very high medical expenses relatively you are covered with Pharmacare.

A person on Income Assistance or on Disability has their prescription medications covered and Seniors will have some or all covered as well depending on income. It is a pretty good system, though I sometimes am concerned over how much Seniors might have to pay out of pocket before they are eligible each year at the beginning of the year - after all, their income is the same whether that month is December or January. But that is one of those things in the nature of looking at ways that even something good can be improved.

What got me wondering is one of those situations that makes me frustrated. A person goes into the hospital emergency room for a health emergency - in this case kidney stones - and is treated and sent home with prescriptions for some medications. Now not having benefit of someone else to do so, they stop at the pharmacy on the way home from the ER to have the prescription filled. When the pharmacist calls them back up to the desk with the prescription filled: pain killers - check; antibiotics - check; medicine to make it easier to pass the remaining kidney stones - $13 please, it's not covered by MSP. -blink- Now someone frugal who always has some money socked away for emergencies this is not too much problem, but if you are covered by Pharmacare you are guaranteed to be someone who has a very low income. Even the most frugal on an income assistance budget has problems saving even $5 from month-to-month and it is the same $5 bill not one that can be added to the last. At the beginning of the month it is possible to do if they go with a little less food for the month. But for a person on income assistance, they are already feeling the pinch of even the bus-fare to get home from the hospital.

I am not in that situation, but that $13 might be the $13 a person might be counting on for cab fare home from the hospital instead of standing on the bus - or maybe buying something at the grocery store they might not need too much preparation for - or perhaps some of those non-prescription medication things that aren't covered. They don't cover the simple pain killers that you buy off the shelf, antacids, antihistamines, off the shelf laxatives or anti-diarrhoea medicatio or things of that nature. That $13 can be very important to those very people who are on a program like Pharmacare. For me, the $13 just made me grumpy, though I still smiled and was friendly with the pharmacist - as much as I could while feeling dazed and exhausted and in pain.

I can see that they have to have some limits on what is covered. For instance I can easily see that baldness cures might not be covered or medications intended for wrinkle treatment. But I think even then... there might be some circumstances... but then that might be covered by those very same special circumstance.

I can see that they want to make sure that people are not getting medicine that is not needed. You don't want to waste money when it is being covered by government. But... is it the government who is supposed to be judging if a person should be getting a type of medicine? Isn't a Doctor supposed to be the judge of what is in the best interest of the patient for their treatment taking into account the cost of treatment and the best benefit to the patient? Wouldn't they be the person to make a decision on whether a patient really might need a medication or perhaps in some cases the slightly more expensive one?

Now in the case of the medication for the kidney stone treatment, it is not a "Cadillac" treatment... mind you that $13 is only for 7 days... That doesn't mean that it is almost $2 a day, there is also the dispensing fee on there that would be the same even if it were $0.02 a pill. The medicine relaxes the "tubes" so that the stone can pass more easily without as much pain and I am assuming with less cutting and scraping. That means less chance of bleeding and infection and less chance of it getting blocked and causing complications like damage to the whole system including kidneys? True, if the stones are larger than a certain size or very sharp and pointy - I guess - they will blast them with sound waves and turn-em to gravel or in worse case operate. But reducing suffering must be a part of what is a legitimate use of medication covered or they would not be covering the pain killers - right? The same medication is used for treatment of prostate enlargement.

Granted, the Doctor said that this is a newer protocol for treatment of kidney stones and could be foregone, but... if the Doctor advises it, who is the government to "play doctor" and say know when they don't even know the case? If the government doesn't trust the Doctor to make the judgement call with some medications why do they trust the Doctor for so many other things like the signing of passports and other documents in addition to all the medications and treatments they can prescribe.

It wouldn't be so bad if there weren't some mechanism in place that a person might use to complain and perhaps request the money back on a situation by situation basis. I know that if I went to Income Assistance they would tell me that "We won't reimburse people for expenses already paid for, but if you put in a request before paying we might be able to have a cheque written for you." That might be fine for some things... but I bet they aren't going to go and make the trips to the bank with the cheque and ministry office and go to the pharmacy to pick up the medicine and deliver it - and do that on the day you need the medicine.

It would also be nice if there were simply a place to register a complaint... well no place the pharmacist knows about. I did make sure that she knew I wasn't angry or frustrated with her. She really has no control over the situation either. She has to go over the regulations of what is covered and what isn't as well and is in the path of the firing range of the frustrated customers whom she wants to keep as good customers.

My plans... well I plan on writing my local political representative. Since BC Pharmacare and MSP are Provincially managed that would be my MLA. She is always happy to hear from her constituents because she like to hear what people think. Unfortunately she is on the opposition side of the house this time. Though perhaps it doesn't matter as someone on the Governing side of the house might be limited if they are complaining? Anyway I think it worth writing as I have found that indeed a person's voice can be heard - especially if what is said is reasonable, and rationally presented. I am not just seeking help in a specific case. Not just "me me me" but for other people with other medical needs as well - perhaps not the greatest of needs medically, but also not requiring the building of a new hospital. Even just a mechanism for complaining or making a request at the pharmacist level? - to request a reimbursement or a mechanism that a person who doesn't have the resources might get that - oh so cheap to most - medication which might make a big difference.

On the other hand... some of these minor things can lead to complications and an ounce of prevention... Still things are improving and have improved. Which I think is why it is important to speak up and speak out and also why it is important to know how to speak out reasonably and rationally and how to find out where to seek out who to speak to. Get the right ear and things get done. Yell in the wrong ear and you are just a nuisance.

~ Darrell


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Sylvia said...

I think your article describes medical insurance and disability beautifully. It is so true that they second guess the doctors. Don't they trust that your doctor knows the best course of treatment for you? Kudos on your article!!!

Darrell Wade said...

Thanks Sylvia!
I realize now that the Doctor said the medication is a new protocol for passing kidney stones they don't do the sonic zapping or other slighting more invasive treatments on. So perhaps it just isn't covered yet... but still... Last pill tonight. I wonder about getting a refill... Sigh this has kept me from my writing schedule. :-(

~ Darrell