Self Pay Health Care

Self-pay is the basis upon which the healthcare financing system began. Patients paid physicians a fee-for-service. In its purest sense, the self-pay model includes only the physician and patient in the exchange of compensation for medical care provided. Over the years as healthcare financing arrangements have changed, entities paying a fee-for-service includes all payers-public and private. Some in the healthcare industry has referred to physician practices that do not accept health insurance as cash-only practices or self-pay patients. Self pay vastly reduces the traditional overhead expenses by not having to bill and abide by contractual requirements of third party payers. Further, collection rates may be higher with fewer bad debt expenses. Physicians in a pure self-pay practice may want to continue to see patients with private insurance who are willing to pay cash and submit their own claims. Before charging privately insured patients on a cash basis, the physician should determine that there are no contractual or legal restrictions on doing so. This will necessitate a review of existing contracts and state insurance regulations. Certain states protect enrollee’s in particular private insurance plans from being billed for any sums beyond what the insurance company pays, except for co-pays and deductibles. Some physicians have found the self-pay model a way to regain meaning in and control over their practices, as well as to reestablish a physician-patient relationship in which there is time to care. Another option to consider in not accepting health insurance is to combine a self-pay model with a retainer practice. This hybrid practice would allow patients who could not afford a monthly retainer fee, to still receive care in their personal medical home and only pay for the medical care provided. For more information on retainer fees, see the discussion paper on retainer practices.

Insurance Protocols

Insurance companies use statistics to define protocols for the average patient and the statistically most cost effective treatment. These results in rules requiring doctors to get approvals from insurance companies to do procedures or prescribe certain drugs hinder doctors' ability to provide good timely care. Insurers are in the business of making cost effective health care decisions. Insurers often require doctors to get approvals before they can authorize certain types of care in an attempt to save costs and prevent unnecessary procedures. On average, this can be cost effective for the insurance policy. However, for many, those decisions result is slower treatment, worse outcomes, and adverse side effects.

Breast Engorgement

Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. Engorgement usually happens when the breasts switch from colostrum to mature milk often referred to as when the milk comes in. However, engorgement can also happen later if lactating women miss several nursings and not enough milk is expressed from the breasts. It can be exacerbated by insufficient breastfeeding and/or blocked milk ducts. When engorged the breasts may swell, throb, and cause mild to extreme pain. Engorgement may lead to mastitis inflammation of the breast and untreated engorgement puts pressure on the milk ducts, often causing a plugged duct. The woman will often feel a lump in one part of the breast, and the skin in that area may be red and/or warm. If it continues unchecked, the plugged duct can become a breast infection, at which point she may have fever or flu-like symptoms. Breast engorgement is caused by an imbalance between milk supply and infant demand. This condition is a common reason that mothers stop breast-feeding sooner than they had planned. Breast engorgement can occur due to four main factors such as a suddenly increased milk production that is common during the first days after the baby is delivered or when the baby suddenly stops breastfeeding either because it is starting to eat solid foods or it is ill and has a poor appetite. Breast engorgement may also be caused when the mother does not nurse or pump the breast as much as usual. After the first 3 to 4 postpartum days, the quantity of colostrum is quickly replaced by an increased milk production.
When milk production increases rapidly, the volume of milk in the breast can exceed the capacity of the alveoli to store it and if the milk is not removed, the alveoli become over-distended which can lead to the rupture of the milk-secreting cells  Accumulation of milk and the resulting engorgement are a major trigger of apoptosis, or programmed cell death, that causes involution of the milk-secreting gland, milk resorption, collapse of the alveolar structures, and the cessation of milk production. Severe breast engorgement can lead to the flattening of the nipples or, it can result in inverted nipples which make it impossible for the baby to suck out all the milk from the breast. This is one of the common causes of the stagnation of milk in the breast. Not all women experience breast engorgement after they give birth and some degree of engorgement of the breast is however normal within the few postpartum days. Women with mild to moderate hypo plastic breasts with a wide intramammary space >1 inch and a tubular shape are at particular risk for producing less than 50 percent of the milk necessary for the first week. More concerning are the moderate to severe degrees of breast engorgement. In these cases, the condition can continue for up to ten days or more even though the patients will experience serious symptoms only during the first six days. Overfilled breasts can lead to severe engorgement due to waiting too long to begin breastfeeding the baby, not feeding often enough or due to small feedings that do not empty the breast, very common in cases when the baby is fed formula or water. As women are naturally prone to suffer from some degree of breast engorgement, the main part of treatment is prevention. This means breastfeeding the baby whenever he or she seems hungry and making sure that the baby is latching on and feeding well. In cases when the baby is not hungry enough to empty the breasts, the breast should be nursed or pumped. Avoiding caffeine and chocolate as well as wearing a well fitting maternity bra with wide straps that do not scratch and with a cup that comfortably holds the entire breast usually help in easing the discomfort and other symptoms. As women are naturally prone to suffer from some degree of breast engorgement, the main part of treatment is prevention. This means breastfeeding the baby whenever he or she seems hungry and making sure that the baby is latching on and feeding well. In cases when the baby is not hungry enough to empty the breasts, the breast should be nursed or pumped. Avoiding caffeine and chocolate as well as wearing a well fitting maternity bra with wide straps that do not scratch and with a cup that comfortably holds the entire breast usually help in easing the discomfort and other symptoms.

Overloaded Physicians

All of the professionals in our healthcare system struggle under the crushing weight of cost control measures imposed by insurers and medical institutions, which force doctors to minimize the time they spend assessing, treating, and discussing options with patients and their families. Protecting a family in an overtaxed healthcare system requires expertise. The statistics on medical errors, while often quoted, are still disturbing. In the United States, over 70,000 people die every year because of preventable medical errors that occur in hospitals. That means these avoidable mistakes kill more people than breast cancer or traffic accidents, making medical errors the eighth leading cause of death in the country. The report found that these errors were not the result of individual recklessness on the part of caregivers, but basic flaws in the organization of the American healthcare system. The treatment of over 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression, and other chronic illness is inadequate. Due to cost constraints and resource limitations, doctors are not able to spend adequate time with their patients and do not necessarily have access to information on all available forms of treatment. In addition, when patients see more than one doctor, their care, medical records, and medications are rarely effectively coordinated. The burden of managing treatment most often falls on the shoulders of the patient and family who are already overwhelmed by having to deal with a serious illness. The average office visit is 10 minutes and physicians may be seeing as many as 40 patients a day. In addition, there are long waits for rushed appointments, the confusion about what types of care are available and best suit the needs, and the stress of navigating the U.S. healthcare system. When dealing with a serious medical situation, it is only natural to be overwhelmed. People tend to be confused about their options and too distracted or upset to ask the important questions. IPA Health provides private health management services.