Thursday, February 03, 2011

The Case of Tonsillitis

A couple of nights ago I started to get a sore throat. I thought it was merely the onset of my usual winter sinus infection. However it quickly became an acute tonsillitis (though not as bad as that photo). A friend who is an RN suggested it might be strep, and I should get it checked out. Now the interesting thing is that if it is strep, they don't really treat the strep, as it would resolve on its own quickly, and they don't feel the need to use antibiotics to speed that up. However, they do proscribe antibiotics, because in some rare cases it leads to nastier things like rheumatic fever.But if its viral, like Epstein-Barr or something else, then antibiotics are definitely ineffective. But here again, they are part of standard practice, because it is a good idea to give antibiotics prophylactically in case the tonsils develop a secondary infection or abscess. Its highly unlikely to be EB since I've had it twice, and I'm a bit too old to get it. Plus they wouldn't treat it even if I did.  

So what do we have here. I have a bad sore throat, which has a very high probability of being nothing more than a bad sore throat that resolves on its own, in fairly short order. And I have a prescribed antibiotic, regardless of the outcome of the rapid (though less accurate) strep A test.

Option 1: So if I never went to urgent care, I'd probably be ok. Cost = $0 (actually 2.89 for some Ricola)

Option 2: If I was able to write my own antibiotic script, I would almost certainly be ok. Cost $5

But here is what I did to figure out.

Option 3: I went to urgent care, because the ER would have cost me a $60 co-pay (I know, ridiculously cheap but still enough of a disincentive to wait for the urgent care to open in the morning). I met with a triage nurse, who took my vitals and swabbed my tonsils. The rapid strep A test was run, followed by a meeting with a Doc, who explained the protocol to me and answered my questions. Then he came back in and gave me the rapid results and order a follow-up long strep A test. Cost $ 200* (my actual out of pocket cost is $0)

A lot more money was spent for an outcome that 98% (a guess) of the time is identical to the the do nothing case, and 99% of the time identical to the self prescribed antibiotics. I leave room for that 1% of cases where I may have had other symptoms they noticed that lead to a problem, and the fact that he explained what to watch for that would require me to come back in (more acute pain...really? no shit.).

I view our expensive system as a sort of insurance against catastrophic outcomes.

* This is purely a guess at the moment, I think the Urgent care visit is around 86 bucks and I'm guessing the tests are around $114 or so. I'll try to remember to update it when I get the statement of benefits, which usually takes about 2 months.

Update: Just got the bill. The billed amount was for $224.00, but I'm unclear if this includes the labs or if it is just the doctor's time. The preferred provider  discount brings it down to $168.00. My cost was $5.00 co-pay for the antibiotics. 

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