Shelly Mesure, MS, OTR/L

I recently had the opportunity to speak at the China Healthcare Sourcing Summit in Hangzhou, China. It was a remarkable experience and really helped me gain a wider perspective of healthcare delivery around the world. Access to healthcare, hospitals, doctors, and especially rehabilitation services is a primary concern for the Chinese government.

As I participated in various conversations about comparisons with the U.S. healthcare system, I started to realize access to healthcare there shares many of the same concerns with the U.S. system. For example, accessibility to specialty services in rural areas. In my travels throughout the U.S., I know examples of small, rural towns having limited access to medical specialist, and in some cases, this includes rehab. One town I passed through was fortunate to have two speech therapists; however, these two SLPs worked at the hospital, in home health, and at skilled nursing facilities to cover the demanding caseload.

Another cause of limited access is cost. In China at this time, the government healthcare program does not reimburse directly for rehabilitation services. Everything is considered “private pay” for these additional services. In the U.S., we are fortunate to have every level of insurance companies recognize and pay for physical, occupational, and speech therapy services.

However, from my personal experience, I’d like to explain this hypothetical, yet very real, scenario. I am lucky to have full health insurance coverage. I have an HMO, but getting referrals and dealing with the paperwork is the least of my concerns. But my co-payment for visiting a specialist (including rehab) is $50 per visit. A few years ago, I broke my leg. No surgery, but it was casted for four months.

I needed three-times-a-week physical therapy for four weeks to initiate my rehabilitation process. This cost me $150 per week out-of-pocket (private pay) and I wondered how I was going to afford it.

I’ve been talking with a lot of outpatient clinics and private practice owners, and they share the same complaints. Patients are choosing to limit the number of treatment visits, such as once per week, to off-set some of the healthcare costs. We hear a lot of reports on providing healthcare to the uninsured, but I don’t fit into this category.

I think we’re also missing the point on having conversations about access to healthcare for every demographic, socioeconomic status and age. I am not endorsing Obamacare or Romneycare, but I think we need to begin a national discussion on providing access to healthcare services to my demographic as well.

If you must know, I broke my leg during my first and last attempt at skydiving. No regrets, despite the two-year rehabilitation process I needed to make a full recovery. It was a clean break of my right leg tibia, and four months in a long-leg cast. Physical therapy co-pay = $50; endless visits to the orthopod, X-rays, and follow-up appointments.

But gaining the perspective from the patient point-of-view = priceless.

Shelly Mesure (“Measure”), MS, OTR/L, is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a much sought after speaker and writer on therapy and reimbursement issues.