Monkey in the middle – how rising healthcare costs hurt patients

shutterstock_64541557~Dr Linda Girgis

These days, it seems like everyone’s hands are dug deep into the healthcare system. As the largest expenditure in the US, it makes sense that entities want to profit from this system. However, few of those diving for healthcare dollars truly care about the main aim in healthcare: the patient. Patients get stuck as a monkey in the middle, and doctors work to carry them in the right direction.

Healthcare costs sky-rocketed out of control in the last decade. Companies, both private and government-run, are attempting to drive these costs down. Why? Third party insurance companies do so to increase their revenue and profits. The more they decrease the costs, the more money goes directly to them. The government does so out of budgetary concerns. They have not done such a good job in repairing and maintaining our economy. The Medicare system has struggled to remain solvent since its inception. And it was based on a flawed SGR formula, which was repealed last year. Part of the government’s reason for diving into the healthcare ocean is to attempt to fix what was broken. Many healthcare policy experts believe the Medicare system is not solvent in the long-run. Yet, they continue mandating amends to save face and push their political agendas through.

But where does that leave the patient? It is hard enough being sick or in pain and not knowing what may be causing it. The patient puts their trust into their doctor to offer them the right advice. If the doctor orders a test, many times the insurance company denies covering it. And then an appeals battle ensues which can drag on for weeks, while the patient’s suffering continues. Rather, they now still suffer and frustration is added onto this. The patient gets caught up in the middle. Doctors try their best to get those tests covered, but insurance companies have no incentive to give approval. And we all know patients cannot afford to pay for these tests out-of-pocket. If they did, no one would need to pay health insurance premiums.

A similar experience occurs when patients go to the pharmacy to pick up their prescription medication. They did their part. They went to see their doctor and decided on a course of treatment with their doctor’s advice. Yet, they are often surprised to find their medication not covered at the pharmacy counter. Frantic calls are made between patient and doctors office, between doctor and pharmacist, between doctor and insurance company in order to try to get the medication covered. Meanwhile, the patient is left in pharmaceutical limbo without their medication. They are again stuck in the middle as doctors and pharmacists fight for their rights to a certain medication while the insurance company clamors down on those healthcare dollars. Cheaper is not always better when it comes to medications.

Doctors are aware of the escalating costs of healthcare. We get it that we need to help curb costs. But sometimes, the patient just needs more. And they should get it rather than being forced to play this game of monkey in the middle.

Patients are a hot commodity in healthcare in our current system. Many third parties are fighting to control them in order to seize a portion of the healthcare pie.  Not only are patients stuck in the middle of these economic maneuvers, but doctors are as well. As a doctor, I should not spend more time throwing down my gauntlet in order to get tests or meds covered for my patient than I do in the exam room with them. It is time that those outside the exam room put down the ball and let doctors and patients decide the best medicine.  Isn’t it time the medical system returns to the patient?


Dr. Linda Girgis MD, FAAFPdr linda headshot is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions.  Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year.  She is a blogger for Physician’s Weekly and MedicalPractice Insider as well as a guest columnist for Medcity News and HIT Outcomes. She has had articles published in several other media outlets. She has authored the books, “Inside Our Broken Healthcare System” and“The War on Doctors”.  She has been interviewed in US News and on NBC Nightly News.

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