Steven Asbill recently offered an insightful reflection on some problematic components of the Affordable Care Act. Asbill points out that “providers can only receive dividends if patients are improving upon completing treatment.” Asbill then poses a rhetorical question: “Why should hospitals be penalized for a diabetic patient choosing not to make the proper lifestyle changes?”
Here I would like to provide an overview of the socioeconomic and spatial barriers that some patients face in the pursuit of “proper” lifestyle changes. Taking medications, going to the gym and choosing healthy foods at the grocery store are all commendable acts that any health care provider would heartily promote.
Unfortunately, these activities come at a price. Gym memberships are expensive, and that organic produce on aisle nine is egregiously overpriced. Wealthy patients thus have an advantage over patients in lower socioeconomic strata because of prices associated with wellness centers and healthy foods.
What about food deserts? Food deserts are geographically defined zones lacking access to fully stocked or reasonably priced grocery stores. In these zones, the nearby trip to McDonald’s is perhaps more attractive than the 15 mile drive (or bus ride) to a legitimate grocery store with healthy and affordable options. Patients living in economically deprived urban zones like metro Detroit or those living in rural areas are particularly vulnerable to the effects of food deserts.
Patients who try to take individual responsibility for their own health through dietary means may continue to fail because of the systematic barriers I have just described.
Taking medications is undoubtedly an important facet of treatment for many patients. A patient who chooses not to take her or his medication is indeed responsible for their own deterioration. Then again, there are many patients, particularly mental health patients, who refuse medications due to forgetfulness or confusion.
Asbill is right when he says that the hospital will not be reimbursed if the patient doesn’t improve as a result of medication refusal. Reimbursement for hospitals is outcome-based under the Affordable Care Act.
However, I argue that the welfare of the patient is more important than the welfare of the business providing the health care. In my current work with incarcerated mental health patients, getting patients to consistently take prescriptions is simply an issue of education and is easily resolved.
Individual patient responsibility is very important, and this overview should not be understood as a rebuttal to this concept. With that being said, it is important to point out that individual responsibility is not the only explanation for a patient’s failure to comply with treatment. The system-level economic barriers I have described should always be remembered when we consider patient success and “proper” healthy lifestyles.
— Josh Tucker, first-year graduate social work student