Patient Advocacy and the Allegiance Factor

As we prepare for Private Professional Patient Advocates Week next week, I’ve been asked by a handful of people what the difference is between a private patient advocate and any other health advocate.

It’s an important question, and the answer is actually quite simple.

The difference between a private patient advocate or navigator, and those found in hospitals, through insurance companies, or other places, is what I call The Advocate’s Allegiance Factor.  It’s based on who is producing the paycheck.

Private patient advocates are paid directly by the patient or the patient’s caregiver and have only one allegiance – to the patient.  The patient’s needs, whether they be medical, navigational, financial or locational – are the prime concern of the patient advocate. Period.

However…

If an advocate is employed by a hospital, her allegiance is to the hospital.  She works for the risk management department and her job is to keep the hospital out of hot water, which she MAY be able to do by helping the patient (or maybe not.) Her job is to keep lawsuits at bay and save the hospital money – which she does by helping patients (but only to an extent – and not if it interferes with the hospital’s needs.)

If an advocate works for an insurance company, then her allegiance is to the insurance company.  Insurers hire advocates to make recommendations that will save them money and help the patient, too.  As long as it benefits both – fine. But if not, do you see the insurer’s patient advocate making a recommendation to the patient that might very good for the patient, but expensive for the insurer?  Not a chance.

Medical home advocates are the same way – they are the same as the advocate who works for a hospital.  It’s great that they are available, and they are probably the closest to a private advocate, but they are still not working directly for the patient.

A private patient advocate’s ONLY interest is the patient and his or her well-being.  There is no one else trying to save the system money or keep themselves out of legal hot water.

Most patients and caregivers don’t understand these differences – yet.  They are still beating their heads against the walls trying to figure out why the hospital’s advocate is giving them the runaround, or why the insurance company’s advocate is sending them to a doctor who is arrogant and condescending.  They don’t realize that in both those scenarios, the help they get will be based on whether they can save someone else money, and not on their health.

To further understand the relationship of allegiance and advocacy, take a look at this description of the profession of private patient advocacy and navigation.

And now you better understand patient advocacy and the Allegiance Factor.

Of course, it begs the question, Can a True Patient Advocate Be Paid by Someone Else?

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FOR PATIENTSFOR ADVOCATES |
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  1. Carol Pickup
    March 6, 2011 at 9:41 am

    I am a volunteer seniors advocate in Victoria, British Columbia and have really enjoyed your posts. My background is a retired nurse and about thirty years of locally elected service as a hospital trustee, school board trustee and a municipal councillor. I am not paid for my advocacy, so my total focus is the well-being of my clients.

  1. March 6, 2011 at 5:54 am

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