Cash only, please

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During some downtime on a recent shift, the docs were gathered around the nurses station discussing insurance and patients.

The general consensus among the OBs present was that the current system of insurance reimbursement was not working for them, and that possibly going to a cash-only system was a good solution to the problem. Apparently in a close-by city, all the OBs have banded together and only take cash for deliveries–making insurance obsolete in the area. Patients who don’t have up-front cash (in the amount of $10K-$20K per the docs I was speaking with) are forced to go outside the city for their care, go on payment-plans if accepted, or use government aid and find a new provider. According to the CDC, 11% of docs have resorted to a cash-only system, and that percentage is growing!

Am I the only nurse freaked out by this idea? I am already seeing substandard care of clinic/medicaid patients by physicians. And now insured patients are being turned away? One OB doc even stated, “If you don’t have 20 grand cash up-front to pay for your delivery, you shouldn’t be having a baby, anyway.” Kinda a shocking statement, right?

I know that insurance companies cause all kinds of problems for docs. And docs who use the cash-only system have less overhead, lighter work loads, can spend more office time with patients, etc. And benefiting the patients, especially the uninsured, is more access to care. Yet those same unemployed, uninsured persons are going to really struggle to pay out-of-pocket for their care. So the benefit to the patient doesn’t seem to add up.

For patients with health insurance–and we pay a lot for our insurance!–our pockets also would have to be pretty deep to pay for healthcare in a cash only system. Office visits and tests can cost hundreds of dollars at a time. Inpatient fees are exorbitant. In all, I just don’t see how cash-only is the solution to the healthcare crisis?

More and more the financial aspect of the healthcare crisis is impacting the patients and doctors around me in the workplace–and yes, it is having an effect on care. I have witnessed how patients who have preferential payment receive preferential care, and as a nurse, I just cannot be part of this problem. I have to somehow be part of the solution–if only there was one!

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