As an emerging professional in the field of public health, the current state of our healthcare system is an issue that is always on my mind. I frequently sit in class, learning about the triumphs and failures of our healthcare system. Sitting on this side of the spectrum, we learn about situational cases of people who are denied access to health care, don’t receive quality care, don’t have access to health resources, or are having issues with health insurance. For example, I sat in class the other day and overheard another student talking to a peer about how her grandfather had to liquidate his assets and eventually abandon his ailing wife in order for her to receive the care that she needed because they did not qualify for Medi-Cal or other forms of public assistance. In public health, we want to help find solutions for these populations in order to ensure access to quality health care. We empathize with those who are in need and strive to reduce health disparities. This is the field that I have devoted my career and essentially my life to, but it is also the field that has failed me as a patient.
When I first developed POTS, I went through multiple diagnostic tests and hospitalizations. Being only 18 years old and covered under three health insurance plans at the time, I thought I would never see the obscene hospitals bills that had resulted from the then mysterious illness. I realized when I opened one of the bills in which I owed $100,000, that I was incorrect in my assumptions. After many calls to the hospital and insurance company representatives, it was discovered that the insurance companies were in a disagreement about which would pay for my care, resulting in none of them paying my hospitals bills. Even after the situation was resolved and my insurance started paying my bills, I was still stuck with the consequences. I still am feeling the negative outcomes, as I still find unpaid bills tarnishing my credit score and leaving me with many disputes with creditors and debt collectors, until the situations are rectified.
Currently, I am a 23 year old that will graduate, in June, with my Masters in Public Health about $80,000 in debt from my student loans, but will graduate with thousands of dollars in hospital bills as well. Such a great way to start off my life in the real world. One of my $3,000 hospitals bills that I am currently paying off, using budgeted money from my student loans, is from a surgery that I had last December. My primary insurance will not cover the entire cost of the surgery and my student insurance will not cover any of the cost because I did not have a referral to that doctor. Unaware of the referral process at that time because the doctor was one I was seeing before I had started graduate school, I appealed the claim to the company but lost. Now, I am sick but if I wanted to (which I don’t because I refuse to ever put reaching my goals on hold because of an illness), I could not stop going to school because my loans are supporting my lifestyle and wellbeing. If I stop going to school, at the moment I cannot work full time because of my health issues but I do not qualify for disability or other forms of public assistance and I would lose my student health insurance. What would happen to me if that were my situation? Unfortunately, for many Americans, it is their situation.
It is not just the health insurance side of healthcare that has failed me. It is the quality of care that I receive. The Institute of Medicine’s definition is quality care is “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. Furthermore, patient care should be safe, effective, patient-centered, timely, efficient and equitable. Now, I cannot deny that have received some of the best care at UCLA, with truly compassionate doctors, nurses and other health care professionals that are willing to go great lengths to see me healthy and succeed. Although this is the case, it astonishes me that no matter what hospital in the country I go to, as a patient, I still deal with situations where the quality of care I receive is unacceptable. This is discouraging to someone with a medical condition and if I wasn’t a health advocate myself, I would not know how to deal with these situations. Again, what happens to this who cannot or do not know how to advocate for themselves?
As many people know, I am currently dealing with a situation where I have had almost two months of fevers of unknown origin, greatly affecting my POTS. At the moment, I do not have my port to receive my regular treatment of hydration therapy, so almost every week I have gone to the Emergency Room to get IV saline. That is the first problem; I am stuck misusing ER resources. Secondly, my infectious diseases doctors have ordered multiple tests to help find a cause for my fevers. I have had to wait weeks to have some of these tests performed because my insurance would not authorize them right away. Once they are authorized, I still have to wait for them the tests to be scheduled and performed. This is not timely. In the meantime, these tests could have been performed on one of my many trips to the ER but were not because the concern was “band-aiding” the problem instead of finding a root cause. Instead of wasting my own and ER time, money and resources by returning there every single week, why don’t they find the cause? I had someone try to answer that question for me by saying that they are not looking for a cause because it is not an emergency. In that case, I agree. My situation is not an emergency but it is urgent. At this point, they don’t even run any tests on me anymore, they just give me a liter or two of saline and discharge me. Normally, I would be fine with that, but it has gotten past the point where the saline is actually effective. The longer the fevers go on, the worse my POTS progresses. I am trying to prevent the emergency resulting from the concussions or other injuries I will be receiving when I start fainting frequently. This is clearly not safe. Prevention is not a priority for many, except in the field of public health. One trip to the ER, I tried to tell that to the resident that was handling my case, who proceeded to answer a call in the middle of the conversation but said he would return to listen to my pleading. I understand that he was handling an emergency so I patiently waited, but he never returned and proceeded to discharge me. I left because I refuse to stay somewhere that is not patient-centered and where I clearly am not a concern. This is an urgent situation but yet I still have to wait weeks for some of these tests to be authorized, scheduled and then performed. With my health progressively getting worse and knowing that this degree of sickness could have been prevented if it wasn’t for bureaucracy and a myriad of other factors, is frustrating. These examples are only glimpses into the lack of quality care that I am receiving.
It is frustrating to deal with these issues as a public health professional but it even more frustrating to deal with them as a patient. Interestingly enough, my multiple health issues and personal health experiences are not the reason I have gone into public health and they are not the primary motivating reasons for me to continue this career path. My personal health journey does allow me to fully understand the issues that I work towards preventing and enables me to have a unique perspective. I truly hope that my peers and this generation of public health professionals will be the ones to create innovative solutions so that as a patient, I will no longer feel as though I am failed but will also be proud to be part of the profession.