I’ve spent most of the past year learning about access to healthcare and thinking about how we might improve the patient experience so that patients have better outcomes. It’s become increasingly clear to me that the healthcare system places a high burden on patients, and it is the patient who suffers when healthcare lets them down.

Take this article in the New York Times, New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage. The article explains one of the many things that is all but impossible for patients to understand about healthcare: the difference between in-patient care and out-patient care. Most people think that in-patient care means staying overnight. Not so: there are many ways to stay overnight in a hospital, wearing a hospital gown and sleeping in a hospital bed, where you are not actually an in-patient. The Times article describes being under observation, which can technically be done as an out-patient and still have the patient in the hospital for many days.

The real problem here is the disconnect between what it means to be an in-patient versus out-patient. For the patient themselves, they rarely know if they are in- or out-. They only know that they are at the hospital, and that something is wrong enough for them to stay overnight. Patients have no idea about the strange intracacies of in-patient versus out-patient. To the patient, there is no observable difference between the two. They only find out later when the bill arrives.

Instead of fixing the underlying problem, this change is instead adding to the burden on the patient. Patients now have to be notified if they have stayed more than 24 hours as an out-patient under observation, they could have significant out-of-pocket costs for their treatment. Not only is the patient sick enough to require in-hospital observation in the professional opinion of a doctor, now the patient also has to worry about how all of this is billed. They have to know the difference between in-patient and out-patient. They have to find someone who knows whether the medical billing will be coded as in-patient or out-patient,. And they have to do it at a time when they are particularly ill-equipped to think about such matters.

It’s hard to be a patient. Let’s not add to the burden of being sick, and needing medical treatment, by also expecting patients to make decisions about their medical treatment based on arcane medical billing.