You may be familiar with a biopsy. We take a piece of tissue from some bodily organ—such as the skin—and examine it in a laboratory to look for signs of cancer, autoimmune disease, or other illness.
A sardonic medical joke holds that when patients enter a hospital or doctor's office, one of the first procedures is the "wallet biopsy"—checking the insurance coverage.
The consequences flow from there. Take colon cancer screening for asymptomatic patients. Most people should start with a stool test. Yet those with comprehensive insurance are more likely to be referred directly to colonoscopy.
In the dermatology office, insurance coverage often determines whether you'll be treated with relatively affordable interventions for skin cancer—say, a topical cream—or whether you'll be offered photodynamic therapy ("blue light" treatment), which can cost up to $4,000 per session.
Here's the irony: more expensive doesn't always mean better. These costly treatments can carry their own adverse effects. Studies suggest that physicians, when facing certain procedures themselves—such as some spinal surgeries—often choose more conservative approaches than their more exuberant colleagues recommend to their patients.
The result: our medical care system, shaped by reimbursement structures and access barriers, serves some people more generously than others. Those with robust coverage feast at a bountiful table, though the fare isn't always nourishing. Those on a budget lead lives that are just as important but often less cared for. Let's pay less attention to the wallet biopsy and more to the good health of our entire community.