Barriers to accessing quality health care: finding a good doctor

So you have health insurance. Great! You've overcome what I would define as the first major barrier to receiving access to quality health care (having access to a health system). Now you have to find a doctor. Piece of cake right? Not really. In my experience, finding a doctor can be an extremely frustrating process that comes with its own set of obstacles. These obstacles vary from person-to- person depending on your situation - health issues, where you live, the type of insurance you have, etc. but no doubt propose challenges to anyone who wants to receive care.

I recently had to find a doctor for a loved one and it was no easy feat. If you're like me, you equate trusting a doctor with your (or your loved one's) health, as trusting them with your life and the fate of your finances. So, just any doctor will not do. You want to find a good (scratch that) great doctor, because you never know what could happen to you or that loved one. When you need your doctor the most, you want to feel confident about the person whom you've entrusted with your health because it's scary to think of the things that some people go through - being misdiagnosed, told their making things up and nothing is wrong with them, and unnecessarily spending money on out-of-pocket fees and deductibles that could have been saved or used for other things. This process is so important, that I've decided to share some of the things I've learned and also other tips you should consider when looking for a doctor in the hopes that they can save someone else a bit of time and frustration and hopefully make things at the very least, a little easier.

Before you even start looking, there are a few things to figure out: 

1. Does your insurance policy restrict which doctors you can see with your insurance?

Insurance varies, some policies only offer "in-network" benefits where there are specific doctors they allow their policy holders to choose from. Others have both "in-network" and "out of network" benefits that offer the policy holder more choices in doctors by allowing them to be covered if they see a physician that is outside of their insurance network. Most of the time, the insurance company only covers a portion of the costs for seeing the "out of network" physician compared to the 100% they would cover if the policy holder saw an "in-network" physician.

2. If you need to see a specialist, do you need a referral?

Some insurance companies require that their policy holders get a referral from their primary care physician before seeing a specialist.

After you've sorted out issues 1 & 2 above, now it's time to actually look for your doctor. 

3. There are several ways you can search for a doctor these days:

• Your insurance company's website. Your health insurance website may have a search tool that helps you find doctors that meet your criteria (distance, location, and specialty, etc.).

• If they don't you can try other websites that are designed to help with searching for various things such as physicians like Yelp or physician search focused websites like ZocDoc

4. Once you've identified some doctors, look for reviews of them online.

Although my health insurance provider had a provider search tool, I found the information to be limiting (i.e., doctor's name, address, qualifications). Don't get me wrong, the information they provide is vital but I like to hear feedback from other people to get a more comprehensive picture of the doctor so, I like to do further research by looking at reviews.  Also of note, reviews are helpful but must be looked at objectively. Anyone can write a review and you don't always know the intention of the reviewer - if the review is honest or a lie to purposely ruin or beef up the doctors reputation so I try to look at reviews on more than one site.

5. If you're lucky, you can get a recommendation from family, friends, colleagues, and/or your previous or current practitioner (if you're looking for a specialist).

My loved one received a referral from a doctor to see a specific physician. My thoughts were "great, it can't get any easier than that, I'll make the appointment tomorrow" - until we realized that the referral was for an "out of network" physician. So, just be mindful of this when asking for recommendations. If you can, ask whoever is making the recommendation if the doctor they are recommending accepts your insurance. If they don't know, ask them if there are any additional doctors they can recommend just in case and/or try to get recommendations from multiple sources (e.g., a friend and a family member).

6. Things you'll want to know about the doctors you're researching before you try to schedule the appointment:

• Are they accepting new patients?
• If you're seeing a specialist, does that doctor's office have a screening process before they allow you to make an appointment? In my experience, some specialists will not consider even giving you an appointment unless you've had a "work up" (blood work and/or other screenings such as MRI's) that they feel shows them that there is a problem they should address (as opposed to a different kind of specialist).

In the end, this can be a lot of work and not everyone may have to go through this whole process depending on your situation. There is no doubt that knowing that yourself or a loved one is well makes all the time and stress worth it. But there's a part of me that knows that there has to be an easier way to find a doctor. Like I said, everyone's experience varies but for me this process was very time consuming. If others have had to go through what I did, I can't imagine how much time, work place productivity, and hence more good that could be done for the economy if this process was more efficient.