In which I demonstrate the conflicts in paying for health care

I'm now 8 weeks out of surgery, and it's been pretty slow-going.  For instance:

• I'm still on crutches, and have at least 5 more weeks
• I haven't started any official physical therapy
• I can only bend my knee 70 degrees
• My bone isn't healing as quickly as it should

Now, having said all that, my pain level is very low and if you asked me to choose one word to describe my surgery it would be "inconvenient". 

Because my bone is taking longer to heal than it should, my doctor prescribed me a bone stimulating machine, which is basically a little ultrasound machine I put on my leg for 2o minutes a day.  Unfortunately, these machines cost somewhere in the neighborhood of $2,000 - $3,000.  My insurance company, very cognizant of this cost, will only approve the machine for use if it's been at least 3 months since the fracture.  That means at the time it was prescribed to me (7 weeks) I'd have to wait 5 more weeks to even begin that therapy.  This policy make sense for insurers; most bones will be healed within three months and the machines are quite expensive.  The problem is patients are left languishing on crutches, being much less productive and having a lot more pain.  For me especially, because the minute I'm healed I'm packing my car and moving to D.C., this waiting period is particularly stressful.

But I managed to dodge the bullet because of the FDA.

The FDA approved this device with the stipulation that each couple thousand dollar machine be used only once (which in part accounts  for why the machine is so costly each time to the insurance company).  I asked the device rep why that is, and she thought it had something to do with part of the device contacting the skin, although that part could be easily replaced.   Because the device can only be used by one patient, patients keep the machines when their treatment is done.

By a fantastic stroke of luck, my dad broke a bone in his foot this spring and was prescribed the device.  While he had to wait the three months to get the machine (in part due to the fact he didn't realize he had a fracture for at least a month and half), he used it with fairly positive results. 

We were able to convince the device rep to let me use my dad's machine, so now I'm on the road to recovery 5 weeks faster than otherwise.  In quality of life terms, it makes a huge difference.  But if my dad didn't have the machine, and my only recourse was to pay the $2,000 to have it, I wouldn't (and couldn't). 

These are the trade-offs we need to think about when designing insurance.  On the one hand, it's psychologically frustrating to wait three months for treatment.  On the other, I wouldn't judge this particular treatment worth $3,000 instead of postponing it 5 weeks. 

Comments

[Trapier K. Michael]

Re: "These are the trade-offs we need to think about when designing insurance. On the one hand, it's psychologically frustrating to wait three months for treatment. On the other, I wouldn't judge this particular treatment worth $3,000 instead of postponing it 5 weeks."

Bingo.

[Ari]

It is highly likely that the real reason FDA only approved it for one-time use is that the company only sought one-time use approval. Medical devices tend to be low marginal cost, high fixed/development cost items. Given that, the best strategy is to get it approved for one-time use. Who's going to pay $3K for a replacement pad? Besides, devices are patentable and hard to copy, whereas replacement pads are not. Moreover, once the FDA says one-time use, you've now effectively killed the used market that normally competes with new device sales.

[That Girl]

I know that a lot of people of my aquaintance in blogworld have started to advertize various things they have left over from medical treatments for someone who needs them's use.
I didnt replace my son's nasal canula every week even though they sent me one every week so I sent my leftovers to someone who needed them.
That will also start to take care of the problem.