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A Piece of My Mind
January 16, 2018

Engaging With Patients on Health Policy Changes: An Urgent Issue

Author Affiliations
  • 1Harvard Medical School, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA. 2018;319(3):233-234. doi:10.1001/jama.2017.20257

Back in the 1980s, when I was practicing as a faculty primary care physician at an academic medical center, I had a routine visit with a patient I had been seeing for a long time who was struggling bravely with several chronic illnesses. After a complicated but very useful encounter, as she left she thanked me for all my years of caring for her and said goodbye. “Are you leaving Boston?” I asked. “No,” she replied, “but the people from the hospital said my insurance won’t cover your seeing me anymore, so I have to go somewhere else.” It turned out that similar conversations were taking place throughout the clinic that week. My colleagues and I quickly discovered that a fiscal decision made by a remote reimbursement manager somewhere in the hospital administration had led to many patients like mine being told that their coverage would no longer cover the costs of being seen at our institution, and they should make alternate arrangements.