The Unbundling of Health Care

Tillie arrives at work with an urgent need to pee. A trip to the lady’s room produces little urine but a great deal of pain. She slumps into her desk chair, realizing that she is not going to make it through the day.

She has been treating the early symptoms of bladder infection for three days now—frequent, painful urination. For the last day she has been experiencing chills and running a mild fever. She feels miserable.

She would dearly love to drop in on her old family doctor, but his office is a good hour’s drive from the ad agency where she works. Going there means two hours on the road, plus an hour squirming in the waiting room while her busy physician tries to carve a few minutes out of an already overcrowded schedule.

Tillie has a whole string of deadlines to meet, and a staff meeting later that morning. There’s no way she can take that much time away from work. When she shares her problem with Laura, the office receptionist, she expects sympathy. But Laura just laughs “For heaven’s sake, go across the street to the walk-in clinic. If anyone asks for you, I’ll tell them you’re out on a coffee break.”

Tillie is none too sure, but she has no choice. She puts on her coat and walks the half block to the Urgent Care Clinic. Walk-Ins Welcome, the sign reads. No appointment necessary. No waiting. Physician on duty 24 hours.

No sooner has Tillie completed the enrollment form than she is ushered in to see the clinic doctor. She’s quite young. She looks as if she’s just graduated from medical school, but she seems competent enough. Her questions are brisk and efficient.

Tillie leaves a sample for a urine culture and is back on the street within 15 minutes. Half an hour later, having taken her first doses of two prescription drugs, an antibiotic and a urinary anesthetic, she’s ready for her staff meeting.

Unbundled. Our old, physician-centered health care system was “bundled.” Everyone was supposed to have a primary physician who coordinated every aspect of that person’s medical care.

In the new health care system, the layperson is the key organizer and manager of the exciting new smorgasbord of health choices.

If Tillie needed surgery, her family doctor would find a surgeon. If she needed physical therapy, he’d find a physical therapist. If she needed to quit smoking, he would recommended a stop-smoking program and convince her to attend it.

Today, things are different. It’s unusual to find people who have a single primary physician coordinating all their health care. There are several reasons for this:

  • New health institutions. A variety of new institutions—like urgent care centers—enable us to obtain care with more convenience and less expense. These include walk-in emergency clinics, urgent care centers, ambulatory surgery clinics, and lab testing at shopping malls.
  • Preventive medicine. Our very idea of health has expanded to the point where it now includes many preventive measures that are outside the realm of most doctors’ knowledge, e.g. exercise, nutrition, stress management, and relaxation.
  • Managing our own illnesses. New devices and information allow us to take more responsibility for staying healthy and managing illness. Tillie was treating her own bladder infection with cranberry juice, following a list of guidelines she’d clipped from a magazine months earlier.
  • Alternative therapies. There’s been a recent explosion of information on an ever-broadening range of alternative approaches—from homeopathy to creative visualization. More and more people are mixing the best of physician-oriented medicine with the best these alternatives have to offer.

In the old health care system, the only way to health was through the physician. It was like going to a restaurant with a fixed menu. In the new health care system, the layperson is the key player. People themselves, not their physicians, are the key organizers and managers, the true “bundlers” in the exciting new smorgasbord of health choices.

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Written by Tom Ferguson MD

Explore Wellness in 2021