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Sunday, March 7, 2010

a nearly instant solution to health care woes

Most peoples' health care needs are, or could be, taken care of by a primary care doctor. These needs are not being met because primary care providers are both too expensive and in short supply. A standard doctor's appointment may be billed at over $100, easily, and cost even more if lab tests are ordered. The uninsured just can't afford it, and the insured are hurting because their insurance costs so much, and this is in part due to the fact that care is expensive, and that patients go for more expensive urgent and emergency care because they can't get in to a primary care doctor.

But primary care is not very expensive at all to provide. A good full time primary care doctor manages 1600-2000 patients at a time. If each one of them paid $200 each year to that primary care doctor, the doctor could make a good salary and handle the 50-60% overhead which is common in medicine. Most of the uninsured could afford that much money, and it is far less than is usually spent on medical care by insurance companies and patients.

So how could this work on a large scale? Right now health care insurance costs per family are around $10,000, and most families use no more than primary care, or would if it were available when they needed it. Out of pocket medical expenses are harder to calculate, but are hundreds and often thousands of dollars for people who go for medical care. This is a lot of money, and makes $200 look like peanuts.

I would propose that all primary care be pre-paid. All insurance companies would rebate their insured $200 to be used to sign up with a primary care doctor. For this, they would have regular primary care when they needed it, and the doctor would not have to bill the insurance company and the patient would never have to worry about costs. $200 would probably also cover lab tests done in the doctor's office, since the overhead involved in billing would be gone, and the doctor would be able to see significantly more patients because they wouldn't be wasting time associated with documenting billing codes and time spent in order to be paid by an insurance company. At the end of a year, the insurance company would calculate the amount of money they saved (which would probably be huge due to savings on claims management staff and reduction in spending related to insured patients not getting timely preventive care) and would then be required to rebate a certain percentage of their savings to the patient and to the entity paying the premiums (employer, government or individual.) Everybody would win. Doctors would make an good salary and not hassle with billing. Patients would either get money back on insurance premiums, or in the case of medicare and medicaid, have some kind of a health related rebate, employers would pay less and medicare and medicaid would see their costs significantly lower. If a patient decided to go out and spend their $200 check on beer rather than on medical care, they would not get a rebate at the end of the year, and would also not be eligible for open access primary care.

This would not deal with every problem in medicine.  It does nothing to deal with the high cost of hospital care, and doesn't deal with specialty care issues. It does, though, reduce overutilization because getting adequate primary care keeps patients out of emergency rooms and hospitals where much of that overutilization occurs. Also, in this system, patients would have some pressure not to partake of excess CT scans and consultations because these would be paid under the old system, complete with complex bills, copays and out of pocket costs. Since satisfaction would be higher in primary care because frustration and wasted time would be lower, it would probably make more medical graduates go into primary care, and reduce older physician burnout.

1 comment:

Anonymous said...

Do you remember the day when health care wasn't so expensive? You cover how health care use to be.
When we were kids, my Dad didn't have health care coverage for us. Just him and my Mom. My Mother treated all our ailments at home and the things she couldn't fix we went to the Dr. She paid in cash or if it more in-depth she made payments. Then came along the civil lawsuits and mandated HMO's. That is when the health care became a money making industries for the HMO's.
Get rid of the government regulations and quit mandating what insurance companies have to cover and let the Dr's be Dr's.
My Brother in law did not have medical coverage for 18 months, while he waited till medicare started coverage for him. He has diabetic and high blood pressure and had suffered from a stroke the previous year. He saw a Dr once every three months, his office visit was 55.00 and then additional 60.00 for his lab. The most expensive thing was his medicine, which was well over 200.00 a month.
Now he is covered my medicare but has to have a drug plan and supplemental coverage. He is paying more then before. Something isn't right.