The purpose of this discussion is to apply an understanding of the financing of health care in the United States to a particular patient situation.
Scenario: Widow Mary and a Broken Bone
Mary, an 85-year-old widow who lives independently in her own apartment, has surgery to fix a broken bone sustained in a fall. The surgeon recommends 6 weeks of rehab, and Mary goes from the hospital directly to a private rehabilitation center, where she lives for 6 weeks as she recovers, assisted by daily physical therapy and occupational therapy. All costs of the rehab center are paid for by Medicare and her secondary private insurance. At the end of 6 weeks, she has made significant progress, but is not walking well enough on her own to live independently. Her stay is extended for 2 weeks, and paid for by Medicare.
She continues to make progress in physical therapy, but still not enough to live on her own. The social worker at the rehab center explains the choices:
- Mary can return home, with the assistance of a physical therapist three times per week for 4 weeks, covered by Medicare.
- Mary can stay on at the rehab center, but none of the costs will be covered by Medicare.
She opts to go home, but finds it difficult to navigate her apartment independently, and requires a full-time aide. The costs of the aide’s services are not covered by either Medicare or her secondary insurance. Three months later, Mary still cannot manage on her own, and continues to pay for aides from her own resources.
Use the scenario to address the following questions:
- Assess the sources of funds available to the patient in this case. To what extent do the financing entities limit the patient’s ability to make choices about care?
- Assess the financing alternatives available to a health care provider like the rehab center in the scenario. To what extent does a provider have the freedom to act in the best interests of the patient?
- What ways, if any, do you see possibilities for the patient to have had a better outcome in the scenario?