STEVE INSKEEP, HOST:
Today in Your Health, the frustrations of gaining access to health care. This isn't about being able to afford it, just being able to get it. A typical scenario goes like this - you go to the doctor's office. Then you run across town for a blood test. Then, maybe, you also need an X-ray or an MRI.
RENEE MONTAGNE, HOST:
There's a good chance this will all require a phone call to your insurance company. But for many people, there's a catch. About a third of working Americans say they don't get paid leave to do any of this. That's according to a new poll out this morning from NPR, the Robert Wood Johnson Foundation and Harvard's T.H. Chan School of Public Health. And as NPR's Alison Kodjak reports, without paid sick days, the inconvenience of the health care system can turn into a crisis.
ALISON KODJAK, BYLINE: Tammy Davenport needed an MRI.
TAMMY DAVENPORT: I couldn't walk. I couldn't do anything. I was not really working the way I should've been working.
KODJAK: About 15 months ago, she injured her ankle in a fall. Davenport has hemophilia, a disorder where people bleed excessively, often into their joints. She ended up in the emergency room - could barely walk for a month. Now, more than a year later, the ankle still hadn't healed properly. So she went to a doctor, and he ordered the test.
DAVENPORT: It took me eight hours on the phone, one full day of work, to get an appointment for an MRI, you know, within 15 or 20 minutes of my house.
KODJAK: Why did it take so long? You see, to control cost, Davenport's insurance company set up a system where an outside contractor schedules the test. The company insisted on making the appointment at a center that was 90 minutes from her home, even though its website listed several much closer. It's just one example of the time and energy people with chronic conditions can spend dealing with the health care system. Davenport has to care for herself and her son, who also has hemophilia.
DAVENPORT: It's hours. It's a full-time job. Yes, it is.
KODJAK: That work and hassle of being a patient is exactly what Victor Montori of the Mayo Clinic studies. He says the health care system is designed for the convenience of doctors. And the result is that patients find themselves running between doctors' offices, labs, imaging centers and back, often carrying their records along with them.
VICTOR MONTORI: That is not an organization of care that started by thinking, how do we meet the needs of the patients?
KODJAK: And if patients don't do everything right - if they don't get their tests, or refill their medications on time, or go to follow-up appointments - they are deemed by the health care establishment to be non-compliant.
MONTORI: We just decide that it's the character of the patient that is to blame, and we move on, rather than reviewing our own behavior as health care system and see how is it that we have created so much work for people that they no longer can do it.
KODJAK: So what would a health care system that caters to the patient look like? It would be available in the evenings or weekends, Montori says. There would be clinics in schools and near workplaces. Records would be easy to get and keep. Instead, patients miss work or spend their working hours dealing with health care logistics.
Tammy Davenport's employer gave her time off to deal with her medical problems. But not everyone is so lucky. Our poll found that 32 percent of people in the U.S. don't get paid sick days from work. And 24 percent have no paid vacation time. So unless they work odd hours, many of those people lose income if they want to take care of their health. Valerie Hesse, a catering chef in New Orleans, is one of them.
VALERIE HESSE: I've had allergies to pollen and dust and everything else since I was a kid. Over the years, it got to the point where I was having frequent sinusitis, sinus infections, occasional bronchitis.
KODJAK: Hesse was at the doctor a lot to deal with those sinus and ear infections. She tried to schedule the appointments around her work hours. And sometimes her doctor would give her a break and prescribe her antibiotics over the phone. But it didn't always work out.
HESSE: There were some times where I had to reschedule, postpone, skip. Yeah, I wasn't going to get paid. And you got to work.
KODJAK: The constant congestion and infections were damaging her hearing. So last year, Hesse finally decided to have surgery to fix the problem. The surgery itself wasn't bad, but the recovery took weeks.
HESSE: Especially down here in the culinary field, if you miss work for any reason, you're seen as unreliable.
KODJAK: By the time she got back to work, the damage was done.
HESSE: The owner of the company told me that he had made a management change in the culinary department. And I was - I was let go.
KODJAK: She's now living off savings as she makes plans to open her own catering business. While the lack of sick leave is a real problem, many doctors say complicated rules imposed by Medicare and insurance companies are making it worse. For example...
KRISTINE LONGSHORE: You can't do multiple procedures at the same time or the same day without having the second procedure payment cut.
KODJAK: Kristine Longshore is an ophthalmologist in Doylestown, Pa. She says if a patient needs an operation on both eyes, she, as the doctor, is paid less if she does both at the same time than if she does them on different days.
LONGSHORE: And that's a real hardship for patients. They may have to make one visit to have the right eye treated and come back the following week to have the left eye treated.
KODJAK: Longshore says insurers, including Medicare, are already cutting their payments to doctors. So their incomes are already shrinking. That's why doctors may be reluctant to earn even less by doing two procedures at the same time. But the health care system is beginning to change. And Gail Wilensky says those changes may make things easier for patients. She's an economist who is head of Medicare and Medicaid under the first President Bush.
GAIL WILENSKY: We are in flux as a country in terms of delivery systems.
KODJAK: She says doctors are leaving behind individual practices and joining health care groups that combine specialties and services under the same roof.
WILENSKY: The general move toward better integration of care can be a major improvement and convenience for the patient.
KODJAK: But that transition will take time. It requires doctors and health systems to rethink how they've been doing their work for decades. And in the meantime, people like Valerie Hesse will continue to have to choose between getting healthy and getting paid. Alison Kodjak, NPR News.
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