Shodan, on the “drive-through delivery” issue:
You are probably right that it is cost-effective to send new moms & babies home right away since the vast majority have no medical complications. That’s one example of the entire dilemma of cost-effectiveness in medicine. In this specific case, there are a number of possible poor outcomes that are not manifested within the first 24 hours. If 1000 women return home within a few hours after birth, and a week later one of the women or babies has a problem and becomes more seriously at risk than she would have had she stayed in the hospital, is that outweighed by the savings from not letting the other 999 stay longer? And let’s remember that is "permission, " not “requirement.” If mom feels fine and wants to go home with junior, I don’t think anyone would forbid her to do so.
Other advantages are less tangible. Members of some socio-economic groups are unlikely to return for follow up care; the post-delivery care is all they are going to get. The post-delivery period also is an excellent opportunity for child care education, ascertaining that the nursing process has been begun successfully, and other measures that can improve the overall outcome.
It is similar in my mind to the cost of preventive or screening costs vs. the cost of treatment, as DSeid pointed out. If you (or your parent, child or sibling) is the one saved, do you mind that it was not cost-effective?
I very much agree with you on some of your points. I think it is absolutely true that sometimes doctors order tests and treatments as defensive measures. There should be co-pays to discourage frivolous visits.
There are a couple of posts using the term “medically necessary.” It’s difficult to pin down a universally accepted definition of that. If I don’t get some therapy for, say, spinal arthritis, my mobility and productivity decreases and I will have varying amounts of pain, but I probably won’t die from it. With decreased mobility I may develop unhealthy weight gain and become sick with any of several ailments related to that. Is the treatment medically necessary? Is it cost-effective? Do I care if it is or not?
Decades ago one of my kids needed special shoes to correct an orthopedic problem. I don’t recall if they were paid for by insurance or if they simply became tax deductible, but there was a compensation. This was back in the days, however, when well-baby visits and immunizations were not covered by insurance. (In fact, neither were office visits for diagnosis and treatment of illnesses.) Wouldn’t the special car seat be similar? I don’t know how a seat would be related to a medical condition, but if it would prevent deformity or crippling, then it might actually be cost-effective.
One of my gripes with the effort to be cost-effective is that some of the proposals actually make it less cost-effective. One example is the requirement by some insurers that you can’t see a specialist without an office visit to a primary care doctor, even though it is perfectly plain that you need a specialist, resulting in two office visits (with the requisite red tape) instead of one.
MLS, the key word there is correct. Your child’s shoes corrected the problem, therefore they were therapeutic, therefore it would not be unreasonable to expect your insurer to reimburse you. The car seat, however, did not “treat” the ailment, it was only necessary because of it. Just like my special diet.
Uh … like insulin for diabetes doesn’t correct a problem but is only necessary because of it? I guess it shouldn’t be covered either. No seizure meds and so forth.
It doesn’t correct the problem? Gee, without my insulin I am dead, but with it I can manage to have a1c’s of 6. Clearly I’m just taking it because I like to poke myself with sharp things every few hours. I think you are confusing CURE with CORRECT. Please, don’t be an…well, if I were in the Pit I’d complete that sentence.
We could quibble over what “correct” implies, but to no end. So let me pose a comparison more along the lines of what you seem to have meant: should a wheelchair be covered? Most often it is under “durable medical.”
I do not understand the surprise at having equipment that is needed because of a medical condition covered. It is a cost of having the medical condition. Whether or not it is covered depends on the wording of the plan. The plan in question apparently had wording that covered “durable medical” and tried to weasel out of it. They lost. So what?
Is a wheelchair medical equipment? If so, why not a baby seat? I wish I knew what kind of modification there was, but I don’t. So I will speculate.
Let’s suppose the child had some sort of brain injury or condition that required an apparatus of some sort around his head. He would therefore not fit in a normal car seat without causing injury. We all know that just holding a child in your arms will not protect him in case of an accident, so in order for the child to at least be able to be transported in a car to his doctor visits, he needs a special car seat.
Let’s try another: He has a spinal condition that requires him to be in a brace so that someday he will be able to walk. Again, won’t fit in a normal seat, but can’t be taken off every time he’s transported.
Looked at in that light, it does not appear to me to be all so very different from the brace or the wheelchair. In the long run it might be intended to enable the child to be a functioning adult instead of a lifelong invalid.
Again, I know nada about the specifics of that case, just making a WAG.