Digital Health and Day Surgery - Ways Insurance Companies Can Lower The Cost of Healthcare

I recently noticed a trend in the complaints of many of my patients. One, that insurance companies refuse to cover costs of certain outpatient follow up visits and two, their refusal to cover costs associated with surgery unless the patient is admitted. While I am a firm believer of affordable healthcare for all and feel we must all do our part to ensure this is provided, the former bothers me because insurance companies do not suggest alternatives and the latter astounds me as it contradicts both logic and economics and in the process increases the cost of healthcare unimaginably. I would like to illustrate the latter. Consider a friend and patient who recently sought my opinion. A middle aged male with a diagnosis of carpal tunnel syndrome (this is a common condition where one of the nerves in the hand gets compressed and is very often and successfully treated with a surgical procedure called a carpal tunnel release). The procedure itself can be done within minutes under local anaesthesia and in the majority of patients (my clear disclaimer, "not all"), as a day case. In fact, I have often told some patients in the past that if all goes well, they can literally walk in and out of the operating theatre as many do in centres where I have previously worked. Unfortunately for many patients, their insurance does not cover them unless they are admitted overnight. As a result, resources are unnecessarily and overly utilized. Let me state the obvious. An overnight hospital stay is far more expensive than one involving a day case procedure. From administrative costs to those that are associated with bed usage, medicines and nursing care to name just a few, one can clearly see the cost of the procedure and associated inpatient stay surmounting that of one literally only requiring a patient to, "walk in and out." It must also be mentioned that an efficient day surgery setup allows a greater throughput of patients which equates to resources being maximally utilized in contrast to being unnecessarily and overly utilized. Recent years have seen insurance companies start to dictate their terms and conditions, bullying both patients and doctors in the hope of lowering healthcare costs (so they claim). It thus dumbfounds me as to why many of them insist on a patient having to stay overnight in order for a procedure to be covered. If it is because of the misconception that a procedure requiring an overnight stay must mean it is more likely a necessary one, this myth should be dispelled. To all the insurance companies out there, listen here! Stop insisting on overnight admissions in cases where healthcare costs to not only you but also everyone else in the ecosystem can be lowered through a day surgery approach. And just to briefly touch on the former common issue I mentioned earlier of not covering all outpatient follow up visits...Maybe it's time you start suggesting alternatives, telehealth options probably being one of the best and most affordable. As I believe in the ABCs, always be collaborative. By working with us clinicians rather than against us, together we can lower healthcare costs not only for us but most importantly, for our patients.