I have a character who has whats going to be an infection near the knee...Osteomyelitis, I think. In my country, its six weeks in hospital, IV drugs, please don't move your leg (minimal walking, just enough to keep mobile, etc), with regular tests to see infection levels. How would this work in America's medical / insurance sytem? (btw, my character can either pay through his work or his family, money is not a problem...but if it *could* be an issue, could I have an answer both ways please?) thx
Osteomyelitis is a bone infection that can be really serious or even life-limb threatening if untreated.
Most of the time, osteomyelitis occurs because of an injury- either a wound near the bone becomes infected and that infection gets into the bone, or the bone itself is damaged and exposed to infection (as in a broken bone that broke through the skin). Less often, osteomyelitis occurs when an infection in the blood exposes a section of bone to bacteria.
Osteomyelitis is dangerous because the infection weakens and eventually kills the bone tissue, making it easy to break. The bone can also weep pus or other infected material, which can cause serious infections in the surrounding tissue and blood, which can cause the life-threatening condition sepsis.
Treatment for osteomyelitis usually starts with immediately giving IV antibiotics to prevent the infection from spreading to blood or soft tissue. Since even strong IV antibiotics often have a hard time getting far enough into the infected bone to treat the infection, surgery is often (but not always, if caught early enough) required to remove the infected bone.
An orthopedic surgeon would evaluate the extent of the damage using x-rays or CT scans. In one or more surgeries, the dead and infected part of the bone would be removed. If so much bone needs to be removed that the bone would be unstable, the surgeon may also graft a piece of healthy bone into the area, and the area would be stabilized with hardware.
Non-infected fractures and orthopedic surgeries can often be managed with pins and/or rods on the inside of the body holding the bone fragments together while they heal. Unfortunately, this “internal fixation” can provide places for infection to hide out and re-occur later, so for osteomyelitis-related surgery this will instead be done with something called external fixation- metal rings and pins that go through the skin and into the bone, which will be removed when the bone heals enough to bear weight:
If this could all be done in one surgery, the patient might spend 3-5 days in the hospital. During that time, they would get more IV antibiotics, do follow up imaging and work with physical therapy and nursing staff to learn how to maximize their mobility and care for the pins.
If the decision was made that they’d need ongoing IV antibiotics, they’d also have a PICC line placed. PICC lines (Peripherally Inserted Central Catheters) are like long-term IVs that can stay in a person’s arm or leg for six or more months. This would allow them to come into an infusion center to get the IV antibiotics or even set up the IV antibiotics themselves at home, without having to place a new IV each time. This could in theory be many weeks of IV antibiotics and outpatient visits and imaging (and possibly additional surgeries) until the infection was healed.
So what about the financial aspects? Well, osteomyelitis is a medical and surgical emergency, so it would be handled, at least initially, whether or not the person had insurance/could pay. A public hospital would probably be willing to handle the entire length of care without proof of ability to pay, though if he initially presented to a private hospital and did not have insurance he’d likely need to transfer to a public one for the surgery/care after an initial evaluation.
So he’d probably be able to get the care he needed as long as he consented to it, but whether or not he could afford it on the back end would be another matter entirely.
Now, the US health insurance system is really complicated. Here is a good overview of how it works. For your character, I would expect that he either gets private health insurance as a benefit from his employer (which would cost-share a monthly fee (called a premium) with him, so he would only pay about $150/month as a single person), or he would buy insurance on the “marketplace” (on his own) which would run about $200-400/month depending on the plan.
If he had insurance he would pay up to their insurance’s deductible (the amount of money he has to spend on medical care each year before the insurance starts to work), and the insurance would cover the rest (deductibles can be anywhere from $300 for insurance plans that have high premiums, or up to $10,000 for plans with lower premiums). This at least keeps it in the range of possible for most people.
If he did not have insurance, for the surgery and care afterwards, he’d get a bill from the hospital that could be $100K+ (for reference, this is about double the median annual salary for a US worker). If he’s able to pay it, great. If he couldn’t, depending on income he could get some of that debt waived by various hospital and government assistance programs, and would set up some kind of payment plan for the rest. Or just go bankrupt. A lot of people in this position go bankrupt.
This is why a lot of lower-income, uninsured people in your character’s position would probably wait a lot longer to seek care, may refuse expensive treatments like surgery to avoid debt/bankruptcy, and be unable to afford IV antibiotics to finish the treatment, which for something like this would potentially severely endanger their lives or lead to the need to undergo an amputation to save their life instead of what was described above.
