Friday, September 22, 2006

Broken Health Care System

This is partly why the American health care system is broken:

Botox in several "cosmetic" units (i.e. all the needed areas of a face) takes minutes of time. Cost = ~$1000.
Insurance does not cover this, so patients pay with cash. Cash = immediate revenue = no need to pay someone to try to wrangle it out of insurance companies. $1000 buys a physician a lot more time with each patient. Time means the physician finds the interaction more rewarding. Time means the patient finds the interaction more rewarding.

Compare this to your average primary care provider:
Medicare pays very little for each primary care visit (usually much less than $100 depending on where you practice). If a patient needs a special test, you may never get paid for it if the insurance company does not agree. If you see a patient who needs a special medication, you may have to fill out form after form, and may still never get the needed approval. Frustating for the patient AND maddening for the physician. In an effort to cover operating expenses, to make the same $1000, you must see at least ten patients. Sheer volume of patients means less time with each patient yet more paperwork to be done. Less time with patient = unhappy patient = possibly worse patient care = increased risk of physician burnout.

How come people are willing to spend hundreds of dollars to look good, yet gripe about having to pay a $10 copay for a blood pressure visit? Just based on pure economics, is there any wonder that physicians in all fields - internal medicine, OB-GYN, surgery, Derm, Ophtho, etc. - are all trying to get a piece of the "cash only" pie? And while, at this point in my training, the thought of spending a lifetime performing relatively frivolous services like botox and lasers is distasteful, is this naive? How is a medical system to survive if physicians that are supposed to treat the medical problems of their specialty "sell out" to run a "medi"-spa or open weight loss centers, or run full-time cosmetic clinics? And yet, when one knows about how overworked and underpaid most primary care physicians are, can you blame them for looking for a way out?

photo credit


Blogger prettylady said...

It really seems to me that the only way out is for people to control how their own healthcare dollars are spent, some way, somehow. We do not manage any money so well as when we are spending our own money on ourselves; certainly not when we are spending other people's money on other people.

9:34 PM  
Blogger always learning said...

PL - Agree. Consumers have become removed from the actual cost of their health care. They pay their monthly dues and forget that it translates to paying for part or all of their everyday health care costs. I think people are smart enough that they should have some responsibility in how they spend their health care dollars.

11:15 PM  
Anonymous Anonymous said...

My PCP charges for 10 extra minutes every time I see her. I'd be ticked but 1)I have good insurance and 2)I know why she feels forced to do it. Too bad honest people are driven to deception.

10:45 AM  
Blogger always learning said...

you mean she doesn't actually see you the ten extra minutes?? hm.

i guess that's one way of doing it. the insurance companies do pay really poorly, but that's fraud... i've heard though, that some insurances (perhaps PPO) allow you to bill for the actual amount of time spent with a patient, rather than a giving you a generic "X" amount for an initial or follow up visit. which seems more fair.

10:18 PM  

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