The overwhelming costs of PICU care can financially cripple a family. I see this from time to time, and to me it is the most frustrating part of a medical career I otherwise love. I’ve just seen yet another example.
Parents who are between jobs often have a gap in their health insurance coverage. The federal COBRA legislation provides a way for some families to continue the coverage they had with a previous employer for up to eighteen months after leaving that job, but the cost of that coverage is so high many families cross their fingers and go without any health insurance, especially if a parent expects to start a new job with health care benefits soon. Even though such families cannot afford COBRA coverage, they have incomes too high to qualify for Medicaid. They have no choice but to hope everyone stays healthy.
I have just seen yet another result of that gamble; a child experienced a serious illness a mere week before the new insurance for his family would start, and there is no retroactive coverage allowed. The family’s bill will be in the many tens of thousands of dollars.
I’m not a scholar of medical economics. However, I do have nearly three decades in the trenches of the PICU. As I’ve written before, our current way of paying the costs for critically ill children is dysfunctional; it bankrupts families and discourages the kind of ongoing medical care that can head off the need for PICU care. And this is more than financially expensive — it can cause children to suffer things that might well have been avoided.