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Being in year 5 of a PhD in health policy, I have spent a very large amount of time thinking about waste, moral hazard, unnecessary utilization, consumer decision-making, etc. And yet this week I went to the ED for a broken toe.
It’s a mundane story, but I found it instructive because I’m pretty much the platonic ideal of a consumer and I still ended up making the (socially) inefficient choice.
I know there isn’t much to be done for a broken toe other than buddy taping it and staying off it for 4-6 weeks. “Move as little as possible from a sedentary position in front of your computer” is probably also the recommended course of action for finishing a dissertation, but
trouble is I’m moonlighting as an ICU nurse in my spare (lolsob) time and the pandemic forecast for the next 4-6 weeks isn't v relaxing
I decided it would be prudent to get an xray, bc while most likely injury is untreatable, there’s an outside chance of unstable fx needing a reduction or pin, and I would like some peace of mind re downside risk of not resting.
Wanting to be responsible, I first called urgent care at student health, but xray services were closed for the holiday. Was told I could go nearby ED for xrays if deemed necessary after in-person visit. I’d normally accept the inconvenience, but walking is minimally appealing atm
I inspect my EOB to see how else to get an xray in a timely fashion. My benefits & OOP exposure are clearly stated for ED care, but other coverage is less clear.
I’m trying to be an efficient consumer, but I’m pretty price sensitive & I’m facing a choice of clear (ED) vs unclear (other urgent care? outpt specialist?) access/costs
Plus I’ve spent a not-trivial amount of time trying to figure out what to do and this is def supposed to be a work day for me. Still, don't want to be THAT GUY in the health care costs ppt, so I decide to call an ortho clinic directly
The clinic can make an appt, but says I’m not registered as a patient (but I know for a fact I am, having personally seen my MRN & having had prior orthopedic surgery in this very system) and I first need to call new patient registration
Considering it both rude and ultimately fruitless to argue with the intake person about whether I’m registered, I call the registration line, where I am indeed in the system but nevertheless am asked qs for 15 mins before the important one: insurance
I give my insurance info, which the registration person searches and informs me there are no matches in the system, so I need to call my insurance. Yet at that very minute I'm logged into my insurance website with the exact member ID I have provided (?!?!)
I say thank you and end the registration call – I don’t know why she’s not finding me, & I don't know what is helpful to me about making calls to an org that *isn't* having an issue with my record?
So I have now tried urgent care, but they're not doing X-rays. I've tried the ortho clinic but got sent elsewhere on an admin issue I knew to be wrong. I've tried patient registration and again got sent elsewhere on basis of admin I know to be wrong.
At this point, I still feel a bit bad about going to the ED for a toe, but I LITERALLY COULD NOT be a more capable consumer and I spent hours ACTIVELY FIGHTING the choice architecture that is clearly showing the ED = best choice
Anyways, I went to the ED. It was great.
In the end, it was hard not to conclude I used the system as designed.
To be clear: this wasn't a story of not knowing what to do, I *did* know. The problem was *execution*. The clinic and ED are the SAME ORG, so why did one have me debating a call center worker in the Philippines re existence of my insurance while the ED took same info & treated me
