Mrs. D?Angelo has been into the ER every 3 weeks for 6 months, complaining of painful gallstones. She is a Medicaid patient and does not present with the appropriate symptoms to make her eligible for immediate surgery.

This situation address one of the problems that low-income, Medicaid patients face when seeking medical care for non-life-threatening illnesses. Because Mrs. D?Angelo only exhibits 1 out of 3 blockage symptoms, gallstone removal is considered elective. Medicaid will not pay for the procedure and she will be put on an 18-month waiting list for surgery. After hearing this, Mrs. D?Angelo states that her neighbor had private insurance and got a removal the very next day. Lewis sends her home with a pain prescription.

What are the pros and cons of waiting before surgically removing Mrs. D?Angelo?s gall bladder?
Do privately insured patients get better treatment?
In this case, how are you defining better treatment?
Discussion:

Sometimes, the ?bottom line? can limit the type and amount of treatment a patient can receive. Many physicians realize that waiting for the situation to escalate might cause further costly problems for the Medicaid patient, but cannot provide the patient with the same level of care as a privately-insured patient. Considering the situation presented and the information learned from this class:

Do you think that Medicaid should review their policy on whether this condition and similar ones like it should be classified as an elective surgery, that is, should Medicaid make such diagnosis/condition required or non-elective surgery?
How would any change in this policy affect the cost of health care for that individual as well as all of us?