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2007-08 Schweitzer Fellow Backy Hanson.

2007-08 Schweitzer Fellow Backy Hanson.

As the national debate over health care reform rages, we’re asking Schweitzer Fellows and Fellows for Life — who are working directly with the populations whose needs are unmet under our current health care system — to weigh in.

While a student at the BU-Sargent College of Health & Rehabilitation Sciences and a 2007-08 Boston Schweitzer Fellow, Becky Hanson crafted an after-school program for adolescents with developmental delays, focused on nutrition education and cooking classes.

Now, she’s an occupational therapist. For about four months, she has been working in a small community hospital — and below, she shares three stories that illustrate, in her own words, “how our health care system is broken”:

When I was looking at a medical chart preparing to work with a patient, I overheard the following exchange between doctor and patient in a room across the hall:

MD: “It’s really important for you to make a follow-up appointment with your physician…”
Patient: “Doctors are for rich people. People like me can’t afford to see the doctor.”

This broke my heart. Health care should not be something that is seen as a luxury; it should be accessible to all, especially in such a nation as ours that claims to be one of the most wealthy and powerful in the world. Doctors only for rich people? This should not be.

A bit of background for the next two stories: the hospital I work in is an acute-care hospital, which basically means that patients don’t stay there for long. Patients needing long-term medical management or intense rehabilitation are supposed to be able to move to other facilities that can better meet their needs. As an occupational therapist in this hospital, a large part of my job is evaluating patient’s needs for rehabilitation and recommending the best setting for them to seek that treatment in. However, insurance or lack of it often complicates matters.

For example, the nearest facility offering the kind of intense rehabilitation needed by many persons after a stroke for optimal outcomes does not accept Medicaid — meaning my patients who are on Medicaid and could benefit from this level of rehab often don’t get to go. They end up in a less-intense setting, often a specialized area of a nursing home, and don’t have as much chance for progress.

Should someone’s level of recovery from a major health event be determined by their income? I don’t think so. I remember one patient in particular who was extremely motivated and was making good progress while she was in our hospital. She ended up going to the nursing home with the worst reputation in the area because it was the only one that would accept her Medicaid. I don’t know what happened to her, but I can’t help but feel she would have done better at an acute rehab facility where she would have received 3 hours of therapy each day instead of 1.

Also, there are those patients who are without insurance, which also causes difficulty. If they need to go to any sort of rehabilitation facility after their brief stay in our hospital, they must pay out of pocket. And the people who don’t have insurance usually have difficulty coming up with the thousands of dollars a day needed for such a stay, so they often go home before they are recovered enough to manage things at home — which often results in repeat hospitalizations.

It may be obvious from what I’ve written above, but I think everyone needs to have health insurance first. There are other steps I’d like to see after that to change our insurance system because it is a mess, but as a starting point, every American needs to have insurance.