Exactly JennyP. In home care you see a whole different side of the picture of non-compliance. Spanish people have med bottles with English instructions on them (please don't start the argument of everyone should speak English, when it comes to meds, and a pt goes to a clinic called "Centro Medico", it should be written in Spanish!)
I disagree with selective treatment also. If someone is non-complaint, a social worker should be sent out to identify what barriers there are for this person that keeps them non-compliant. I had one pt who was in and out of the hospital so much, he wouldn't let us fill his mediplanner, but when I became his case manager, I insisted, and we agreed he would try it. Well, he's been out of the hospital for 2 months now, the longest stretch in a long time.
I think that part of the reason that pt's are non-complaint is that they lose faith in the medical system. I can see why. Many patient's who are on Medicaid are not taken seriously by healthcare practitioners. They are lumped into the category of "Medicaid Leach" and so, their complaints and issues go unheard. I have to beg to get a doctor to send a refill for diabetic testing strips and lancets. I have been after one doctor for over 2 weeks to send them to my pt, and this pt tests himself regularly, but they blow him off b/c, I believe , he is Medicaid. How can someone be complaint if they don't have the tools to do so??
I know there are people who suck the system dry, that is b/c they are allowed to. It's easier for some healthcare providers to give in and give that Rx for pain med, instead of determining why a person has such uncontrolled pain. I have experienced many docs and other healthcare practitioners who blow off a pt concerns as soon as they hear Medicaid. Yes there are some select few who suck the system dry, but to categorize everyone w/o a social and environmental assessment is unfair.