Carmelo, the patient. It’s not the sexiest topic. Nevertheless, it has some attractive angles. That’s what I’ve learned about veterinary affordability-related issues over the past few years. Here’s a brief history of the subject: We all know veterinary care has gotten pricier. And there are plenty of reasons for that, which we can enumerate and argue ad nauseam. But it all comes down to one thing: The services we offer are increasingly unaffordable for a growing segment of the U.S. population. Which explains why exam room visits are down in an industry that’s still in overall growth mode. Collectively, pet owners are spending more. But that’s mostly because the haves are dedicating more of their dollars to pet healthcare. The have nots, meanwhile, are increasingly doing without. So what’s a profession to do? Illustrating the differences For a while, pet health insurance seemed like the holy grail to bleeding-heart welfare types who’d end up shelling out the bucks for pets like Caramelo (see photo), whose owners couldn’t afford to pay for care after a run-in with a big dog left him bereft of a mandible. We billed insurance as the antidote to economic euthanasia for patients like these, pets of people who couldn’t otherwise afford treatment. But it hasn’t exactly shaken out like that, has it? Think about it: Owners like Caramelo’s don’t buy insurance. They’d be shocked to hear it even exists, given that Obamacare is out of their family’s price range. Even if pet insurance were as popular as it is in the U.K., these owners would fall into the least-likely-to-adopt-it group. Who benefits from pet health insurance? Educated people like my sister. After her boy Maddie ate some poisoned salmon, he spent weeks recovering at UC Davis. At the time, his claim was the biggest Embrace Pet Insurance had ever covered. But the truly needy? Even if they could afford $50 a month, it’s unlikely they’d scrape together $20K in advance of an insecure future payout. To me, it’s become achingly clear that pet insurance is a woefully inadequate answer to most affordability concerns. While undeniably useful and wholly legitimate as a financial product for pets like Maddie, it nonetheless needs to be said: Pet insurance will not help the Caramelos of this world. For all the praise I lavish on insurance in my columns, blog posts, and exam rooms, pet health insurance only prevents economic euthanasia in the most extreme cases. While it clearly has the power to raise the standard of care of many of my existing patients (and for that I cherish it), it does not adequately address the financial concerns of my less affluent or less educated clientele. Here’s the thing: Our hospital has three kinds of clients. We have 1) the middle-aged and affluent who we’ve long cultivated through word of mouth, 2) the young and well-educated millennials who find us through social media, and 3) the neighborhood locals who frequent the very popular but slightly down-in-the-heels nearby shopping district. It’s a conundrum, to be sure. We can’t be all things to all people, right? And we know which side our bread is most lucratively buttered. But that doesn’t mean we turn anyone away. Though we give services away, to be sure (reference Caramelo again), for the most part we’ve learned how to offer less expensive services to this third group of clients. How? If I’m honest, it happens by lowering the standard of care we provide. This comes down to a) performing fewer diagnostics, b) employing less expensive drugs and supplies, and c) leveraging technical support instead of expending doctor energy. There may be better ways of getting this done, but I’ve yet to hear of one that works for the truly down, out, and destitute. “They shouldn’t have animals,” you say? “Love is not enough!” you argue? Sure. They’re satisfying things to say. But they don’t alter the reality. People will still have pets. And if you think really hard about it, you’d never begrudge anyone a beloved animal companion, regardless of their ability to pay for them. What’s more, I’ll argue that if you do, you don’t belong in this profession. But enough of that … Other options Here’s where some of you might bring up myriad other products designed to improve our clients’ ability to pay: Care Credit (and others): It’s a great product … if your cash-strapped clients have the credit scores to qualify. Nuff said. Payment plans: Think payment plans are way too James Herriot? Think again. If Care Credit won’t have them, maybe you can have a third-party payment plan administrator make it happen. You get paid in installments, and the administrator comes after them if they don’t (for a slice of the action, of course). Sure there’s risk. But that’s business for you. Wellness plans: These á la Banfield plans are a good option for pet owners who want to budget their spending. In my experience, they’re economically rewarding for middle income-serving hospitals that have to bake in compliance and loyalty with a financial tether—less so for clients who don’t have much to spend. While these plans boost preventive care compliance, they’re much more effective as practice builders for hospitals that like to vaccinate frequently than as affordability solutions for needy pet owners. That’s because they’re top-heavy with vaccines, products, and tech work, and rely only minimally on the hands-on vet care cash-strapped clients can’t afford in the event of accident or illness. Public funding: Shelters and other publicly funded institutions are experiencing a surge in redesign of their programs and infrastructure to meet the needs of the “underserved.” But like the not-for-profit clinics in our communities, they offer as much of a solution to the wider affordability problem as donating my services to Caramelo does. Building future opportunities Given all of the above examples, I have faith that our communities can create innovative, low cost solutions for pets of the impoverished. But, just as firmly, I believe these efforts are neither sufficient nor sustainable if we expect them to meet the needs of anyone beyond the most needy. There’s just got to be something between free and astronomical if we’re going to survive as a profession that cares for all pets, regardless of their people’s ability to pay. Or just plain survive. The current state of veterinary financial affairs is a conundrum, to be sure. It mirrors much of what’s also amiss with our country, economy-wide. Tricky as it is, I’ve come to a conclusion anyway: We’re creative. We’re smart. We should be able to look beyond low-hanging fruit like $4,000 TPLOs and $750 routine dentals toward a market beyond the rich and educated. The divide between the haves and have nots poses an enormous risk to our profession, for sure, but it’s also an unprecedented opportunity. Who wouldn’t vie to capture a market bigger than today’s whole pie and save the animals in the bargain? Dr. Patty Khuly owns a small animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.
