(See part 1)
(See part 3)
In game theory terms, Moses Cone and Guilford County continue to choose lose-lose strategies by closing HealthServe... Prospect theory and loss aversion further explain why the region’s health system cannot expect “compliant patients”... The health system contributes to refugee stress
(See part 3)
In game theory terms, Moses Cone and Guilford County continue to choose lose-lose strategies by closing HealthServe... Prospect theory and loss aversion further explain why the region’s health system cannot expect “compliant patients”... The health system contributes to refugee stress
“Help? Why, yes, now that you ask.”
LONGSTANDING HEALTH INEQUALITY can’t continue. Yet the best Moses Cone and Guilford County can do is to close one of two HealthServe clinics located in Greensboro, and send the poor and uninsured to the remaining crowded office on Elm-Eugene. At the same time, Moses Cone has opened its new $15 million cancer center. But as its CEO Tim Rice explained, there’s been a rise in patients unable to pay their bills (News-Record, Sunday, January 15, 2012). Many are refugees like the Montagnards.
Prospect theory has a big influence on game design because it explains how players think about how their decisions will shape the future. Here we can see it at work in real life. A fundamental first step in the improvement of health services must be the recognition that refugees bear substantial health costs before they walk into the doctor’s exam room, into the ER, through the doors of urgent care, or into the dentist’s office. Refugees’ health decision-making is influenced by how they calculate lesser outcomes as losses and greater outcomes as gains. The choices they make are those that have higher utility, which explains why a family decides to avoid the doctor, not to go to urgent care, and not to visit Moses Cones’ spanking new cancer center. When refugees imagine the outcomes of seeking good health care or not, they decide the negatives far outweigh the positives. This leads to some jolting statements made by refugees that are difficult to listen to without feeling their underlying desperation— that they would rather die, would rather lead shortened lives, would rather suffer in silence, would even prefer to return to Vietnam to die rather than stay here in the Triad.
Prospect theory has a big influence on game design because it explains how players think about how their decisions will shape the future. Here we can see it at work in real life. A fundamental first step in the improvement of health services must be the recognition that refugees bear substantial health costs before they walk into the doctor’s exam room, into the ER, through the doors of urgent care, or into the dentist’s office. Refugees’ health decision-making is influenced by how they calculate lesser outcomes as losses and greater outcomes as gains. The choices they make are those that have higher utility, which explains why a family decides to avoid the doctor, not to go to urgent care, and not to visit Moses Cones’ spanking new cancer center. When refugees imagine the outcomes of seeking good health care or not, they decide the negatives far outweigh the positives. This leads to some jolting statements made by refugees that are difficult to listen to without feeling their underlying desperation— that they would rather die, would rather lead shortened lives, would rather suffer in silence, would even prefer to return to Vietnam to die rather than stay here in the Triad.
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x
Anticipated Losses Calculated by the Patient
Before She Ever Steps Foot into the Doctor’s Office
Anticipated Losses Calculated by the Patient
Before She Ever Steps Foot into the Doctor’s Office
Prospect theory states that losses feel worse than gains.
We can estimate these losses:
We can estimate these losses:
• one day of work lost to waiting in a clinic ($49)
• transportation and fuel ($5)
• translator/interpreter ($25)
To which can be added anxiety and discomfort caused by:
• hunger from waiting all day
• an insensitive and/or uncomprehending doctor, nurse, clerk, etc.
• an insensitive and/or uncomprehending doctor, nurse, clerk, etc.
• children at home without supervision or the rush to return before kids get off the school bus
• the likelihood of a gigantic, unpayable bill
• the likelihood of an inconclusive diagnosis and a return trip
• the likelihood of an unaffordable prescription
• feeling of indebtedness by the patient to the relative or neighbor who served as interpreter
• unpleasant feeling associated with reporting the day’s results and the bill to one’s spouse
x
LESSER OUTCOMES > GREATER OUTCOMES
x
x
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How The Health System Views Collaboration
How Refugees Project Health Value
If people would cooperate with its system, the implicit argument of the health system goes, then they would invest more in their personal health. The more they put in, the more they’d gain. A “compliant patient” would operate within the region’s rules, bear all the costs before and after stepping into the doctor’s office, and (of course) the costs incurred while she is in the system. According to the health system, personal responsibility yields the greatest utility (i.e., patient satisfaction).
How Refugees Project Health Value
Like all families, refugee families value health. But they would rather than hold on to what they have than risk losing it. Losing and the idea of losing feels worse than any possible gains. Risk aversion has consequences. Families and individuals will endure and suffer privately, out of the sight of American health experts and local officials. We’ve visited very poor families with little food in the kitchen who paid their hospital bills in full. They are reluctant to pay more. As the saying goes, “Burned once, twice shy.”
Permanent, Unrelenting Stress
These contrasting views about health produce the overwhelming stress in refugees Omer Omer and Y Siu Hlong so eloquently detailed to participants at the first Open Space meeting held at First Presbyterian Church following the collapse of Lutheran Family Services. It is this condition that the American side as a whole regularly fails to appreciate but whose link to diabetes, high blood pressure and other avoidable diseases is well known to health professionals. This condition guarantees that the poor will avoid rather than seek out its health services, guarantees that the poor will choose not to go to the ER. Having transformed good health into an onerous task for the poor, it is easy for our region’s leaders to close down HealthServe’s northeast clinic. By systematically removing the possibility of good health care for the poor and refugee communities, it imposes a new standard: Poor community health as the acceptable norm and its permanent condition. Charitable intervention in exceptional cases at the discretion of the powerful.
These contrasting views about health produce the overwhelming stress in refugees Omer Omer and Y Siu Hlong so eloquently detailed to participants at the first Open Space meeting held at First Presbyterian Church following the collapse of Lutheran Family Services. It is this condition that the American side as a whole regularly fails to appreciate but whose link to diabetes, high blood pressure and other avoidable diseases is well known to health professionals. This condition guarantees that the poor will avoid rather than seek out its health services, guarantees that the poor will choose not to go to the ER. Having transformed good health into an onerous task for the poor, it is easy for our region’s leaders to close down HealthServe’s northeast clinic. By systematically removing the possibility of good health care for the poor and refugee communities, it imposes a new standard: Poor community health as the acceptable norm and its permanent condition. Charitable intervention in exceptional cases at the discretion of the powerful.
