David Sandman

The seasons are changing and the weather is getting cooler. That transition means some nice things: the brilliant colors of fall foliage, hot apple cider, and maybe a snowy winter. It could also bring some not-so-nice things like the onset of flu season.

The 2019–20 seasonal flu infected more New Yorkers—almost 160,000—than ever previously recorded by the State. By comparison, last year’s flu season was mercifully mild; New York had 97% fewer cases compared with the prior year. Flu activity was also unusually low nationally and globally. COVID-19 mitigation measures like mask-wearing, hand-washing, and social distancing likely helped keep flu rates low, but flu vaccination was also at a record high during the 2020–21 season; Particularly with COVID-19 raging, it was vital to ramp up flu shot rates to limit preventable deaths and avoid further straining a health care system that had been pushed to the breaking point.

As we continue to navigate the COVID-19 pandemic, controlling this year’s flu season will be just as important. Public service advertisements are running widely urging all New Yorkers—especially children under age 5, adults over age 50, and people who are pregnant or may be pregnant—to get their flu shots. Getting a flu shot is one of the most basic public health measures you can take to protect yourself and others from illness. It should be easy, simple, and free.

In my case, it wasn’t. Across the street from my apartment building is huge chain drugstore (they seem like they’re on every block in NYC). I’ve been spontaneously walking in there for years now and getting my annual flu shot; no fuss, no muss. I strolled in ready to roll up my sleeve, but this time they refused to give me a vaccine without an appointment. There was literally no one else there, which I pointed out. They said it didn’t matter, maybe people were coming who had an appointment. I said I was happy to wait, wasn’t trying to cut a line, and that I was there and ready to go. But they were adamant: no appointment, no shot. They seemed a lot more interested in following rules than providing health care.

Frustrated, I walked half a block away to the nearest urgent care center. They said sure I could walk in, and it would cost me $25. Why the charge? Thanks to Obamacare, health plans cover a set of preventive services—including flu shots—at no cost to the patient. This $25 “fee” was just outright profiteering, and a barrier to the promotion of a core public health measure. No thanks. It would’ve been free at the drugstore had they been willing to give me my shot.

Now beyond frustrated, I went back to my apartment to make an online appointment at the drugstore across the street. One of the scheduling options was “I’m here now and ready.” (I couldn’t make this up if I tried.) I clicked it, completed the registration, and was granted an appointment for 5 minutes later. I ran back downstairs, got my shot, and walked out.

In some ways, this story is nothing but one of those minor irritations of daily life. I don’t want to sound whiny; I know I have a host of privileges that made this a lot easier for me than it would’ve been for others. I have health insurance. I had the time to weave through this stupid obstacle course to a flu shot. I could’ve afforded the $25, but I also know enough about health policy to know when health care should be free. And I live in a city saturated with pharmacies and other convenient locations for flu shots; it wouldn’t have been so easy for me if I lived in a rural area, where I might have had to drive 30 minutes or more to the nearest drug store, only to be turned away.

The issue is that the story illustrates all too common patterns that characterize a health care system that is not patient-friendly or consumer-centric. We talk all the time about meeting patients where they are, making health care easy and convenient, eliminating barriers, and so on. But I faced a set of wholly unnecessary and arbitrary barriers that made it hard to get health care for myself. And it’s not just about me—flu shots are public health guidance for the good of the population.

As we continue to battle COVID, these reminders about eliminating or at least lowering barriers in health care are especially relevant. To boost vaccination rates, people have gotten creative. Mobile vans are roaming the streets to deliver on-the-spot vaccines, no appointment needed and free of charge. New York City residents can get $100, free tickets, free transit passes, memberships, or gifts for getting vaccinated against COVID-19. Vaccinated people can enjoy giveaways from Krispy Kreme, Shake Shack, and Crunch Gym (at least one of those options is healthy). There are headline-grabbing approaches like million-dollar lotteries, and “shots for shots” events at local bars. Combined with traditional approaches like patient education, all these efforts are designed to make getting vaccinated easy, simple, and rewarding.

One day, the COVID pandemic will be over. But the need to make health care simpler won’t cease. The futurist Ian Morrison offers 4 principles of reducing complexity in health care:

  • Simplicity requires hard work. Just because the patient experience is clear, that does not mean complex structures aren’t operating behind the scenes.
  • Simplicity benefits both providers and patients. Such a business model is easy for consumers to understand, and makes financial sense for providers.
  • Simplicity requires technology. Expect the future to become increasingly digital.
  • Simplicity will put patients at the center of care.  Always consider the patient’s perspective first to develop simple solutions and processes.

I got my flu shot. It wasn’t simple or easy, but I got it which is good for me and for the health of the public. For health care as basic and important as that, there should be no obstacles to maneuver or hoops to jump through. I encourage you to get your shot too, and let’s put those principles into practice as we rebuild systems that empower consumers and promote health.

By David Sandman, President and CEO, New York State Health Foundation
Published in Medium on October 12, 2021

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