Health care maze
16/04/15 05:39
The doctor that I see for routine care is part of one of the larger medical practices in our city. They have several different buildings that provide office space for dozens of doctors including several specialties. They also have an urgent care center for walk-in primary care. In recent years they have installed an automated system to remind patients of their appointments. The machine calls the phone of the patient and when the phone is answered it gives the reminder and other information. The system is sophisticated enough to leave a clearly understood message on voice mail. I’m sure that someone in the practice figured out that such a system costs less than paying a staff member to make those calls. Someone also had to decide what the content of the message would be. The message gives the time and location of the appointment and then reminds listeners that the policy of the clinic is to require payment of all co-pays or deductibles or payment in full in the case there is no insurance at the time of service.
I know that the corporation in charge of the medical practice has the right to set its own payment policies, but it is very off-putting to me that they lead with the financial information. It is almost as if the message they are sending is, “We don’t care about you enough for one of our people to call you, but we care about money enough to make sure that you get the message about our desire to be paid.”
I am struck by how many conversations I have with members of my conversation that contain stories of problems with insurance companies, payments to medical practices, and some of the high costs associated with health care. “I get statements from my doctors, but I can’t figure out what I am supposed to pay.” “Never write a check until the medicare payment has been received by your doctor.” “We’re already $20,000 into the treatments and we don’t know what is and what is not covered by insurance.” “When I asked for a detailed statement, it included charges for medicines that I never received, but that were dispensed ‘just in case.’” The litany of stories goes on and on.
And you don’t have to go very far to encounter very strong opinions about the role of the federal government in health care that range from a desire for the federal government to stay completely out of health care to the opinion that the government should be the primary insurance provider of every citizen. I don’t know how many times I have listened to arguments for or against “Obamacare” from people who don’t have a clue what the law means or how it applies to them.
Capitalism is a marvelous economic system. In open markets competition can drive down prices and provide an effective control to excessive profits and unfair pricing schemes. When it comes to health care, however, there are some problems that arise from and unregulated financial system.
In small markets, competition can lead to expensive duplication of services. Some diagnostic machines such as MRI as so expensive to own and operate that having too many machines in the market drives up the cost instead of driving it down. The costs of the machine are fixed whether or not they are being used. Sometimes the costs can be covered by over ordering of unnecessary diagnostic procedures, but in most cases extra machines in the market result in higher costs for everyone. The same thing is true of hospital beds. You’d think a specialty hospital would provide competition to a full service hospital and drive down costs. However the effect is just the opposite. Losing the specialty services from the full service hospital forces them to raise the price of other services and the specialty hospital ends up raising its prices because the market will bear the increased profit. Frequently in medicine competition drives prices up instead of down.
Capitalism creates shortages. Because of the law of supply and demand, one of the ways to increase profits is to create shortages. In the practice of medicine in the US, this is most apparent in the shortage of doctors. Admission to medical school is so competitive that thousands of well-qualified students are turned away every year. This results in inefficiencies that drive up the cost of medical education and creates a shortage of doctors. If you don’t think there is a shortage of doctors, try to get an appointment for a physical with less than three months’ wait. The shortage of doctors is so severe, that the United States imports thousands of doctors from other countries to meet the demand. In our rural and isolated location much of the ethnic and cultural diversity of our city comes from these imported doctors and their families.
The current climate in medical practice is to scale up. Most hospitals in the US are on buying binges, purchasing all of the private medical practices they can afford. The belief is that size will make them more competitive in a tight market. We have multiple multi-billion “nonprofit” hospitals in our country. While the core hospital is nonprofit, there are plenty of associated profit streams. Big nonprofits outsource services to for-profit companies. A stay in the hospital will result in a statement that is extremely complex. You might receive your room from the hospital, but the person inserting your IV might work for a subcontractor. The people who provide the x-ray work for a different company than the doctor who reads the x-ray. There will be consultants on your case that you have never met and who may not even have ever been in the same city as your hospital.
As is common for my blogs, and much of my conversation, I’m better at pointing out problems than at providing solutions. But I’d love to begin to switch the conversation from the problems to the solutions.
Maybe I’ll get around to that after I spend a few more afternoons listening to the problems of the people I serve . . . and after I make an appointment for next year’s physical . . . and after I get my insurance company straightened out on the charges for a diagnostic procedure . . . and after . . .
I know that the corporation in charge of the medical practice has the right to set its own payment policies, but it is very off-putting to me that they lead with the financial information. It is almost as if the message they are sending is, “We don’t care about you enough for one of our people to call you, but we care about money enough to make sure that you get the message about our desire to be paid.”
I am struck by how many conversations I have with members of my conversation that contain stories of problems with insurance companies, payments to medical practices, and some of the high costs associated with health care. “I get statements from my doctors, but I can’t figure out what I am supposed to pay.” “Never write a check until the medicare payment has been received by your doctor.” “We’re already $20,000 into the treatments and we don’t know what is and what is not covered by insurance.” “When I asked for a detailed statement, it included charges for medicines that I never received, but that were dispensed ‘just in case.’” The litany of stories goes on and on.
And you don’t have to go very far to encounter very strong opinions about the role of the federal government in health care that range from a desire for the federal government to stay completely out of health care to the opinion that the government should be the primary insurance provider of every citizen. I don’t know how many times I have listened to arguments for or against “Obamacare” from people who don’t have a clue what the law means or how it applies to them.
Capitalism is a marvelous economic system. In open markets competition can drive down prices and provide an effective control to excessive profits and unfair pricing schemes. When it comes to health care, however, there are some problems that arise from and unregulated financial system.
In small markets, competition can lead to expensive duplication of services. Some diagnostic machines such as MRI as so expensive to own and operate that having too many machines in the market drives up the cost instead of driving it down. The costs of the machine are fixed whether or not they are being used. Sometimes the costs can be covered by over ordering of unnecessary diagnostic procedures, but in most cases extra machines in the market result in higher costs for everyone. The same thing is true of hospital beds. You’d think a specialty hospital would provide competition to a full service hospital and drive down costs. However the effect is just the opposite. Losing the specialty services from the full service hospital forces them to raise the price of other services and the specialty hospital ends up raising its prices because the market will bear the increased profit. Frequently in medicine competition drives prices up instead of down.
Capitalism creates shortages. Because of the law of supply and demand, one of the ways to increase profits is to create shortages. In the practice of medicine in the US, this is most apparent in the shortage of doctors. Admission to medical school is so competitive that thousands of well-qualified students are turned away every year. This results in inefficiencies that drive up the cost of medical education and creates a shortage of doctors. If you don’t think there is a shortage of doctors, try to get an appointment for a physical with less than three months’ wait. The shortage of doctors is so severe, that the United States imports thousands of doctors from other countries to meet the demand. In our rural and isolated location much of the ethnic and cultural diversity of our city comes from these imported doctors and their families.
The current climate in medical practice is to scale up. Most hospitals in the US are on buying binges, purchasing all of the private medical practices they can afford. The belief is that size will make them more competitive in a tight market. We have multiple multi-billion “nonprofit” hospitals in our country. While the core hospital is nonprofit, there are plenty of associated profit streams. Big nonprofits outsource services to for-profit companies. A stay in the hospital will result in a statement that is extremely complex. You might receive your room from the hospital, but the person inserting your IV might work for a subcontractor. The people who provide the x-ray work for a different company than the doctor who reads the x-ray. There will be consultants on your case that you have never met and who may not even have ever been in the same city as your hospital.
As is common for my blogs, and much of my conversation, I’m better at pointing out problems than at providing solutions. But I’d love to begin to switch the conversation from the problems to the solutions.
Maybe I’ll get around to that after I spend a few more afternoons listening to the problems of the people I serve . . . and after I make an appointment for next year’s physical . . . and after I get my insurance company straightened out on the charges for a diagnostic procedure . . . and after . . .