Sunday, January 4, 2009

From a patient's eyes: Healthcare for profit?

In October, I wrote about our healthcare system in Healthcare Crisis? Reform? What the medical blogosphere has to say. As a patient, understanding what doctors and other healthcare providers face with the deepening and widening regulations is difficult.

It's not that I don't want to help. I do. It's to my benefit. I wrote about that in Dear Doctor, I can help.... But I find it disheartening to read more and more about the problems in various medical blogs with no guidance on how to "fix" it. Yes, I very much understand THERE IS A PROBLEM. Now, why isn't someone (anyone) in the medical arena (i.e. doctors) organizing and using the huge patient base to help?

So, what do I do? I peruse the blogs, read the news, and try to discern what is important. I've found some interesting information. I need to know what you, the doctor/healthcare provider thinks about it.

Businessweek highlighted the Institute for Healthcare in Donald Berwick: Curing the Healthcare System. According to this article, Berwick is a huge proponent of applying business best practices to health care.
"Other industries had long ago started managing for continual improvement in
products, services, cost structures," says Dr. Berwick, who toured Bell Labs, NASA, and Toyota (TM) in the late '80s to see how those organizations approached quality control. "I soon realized that there was a need for this knowledge on a national level."

Does what he says help us? Does this make a profitable business? Is making the practice of medicine "profitable" what we want or need? If it means that a doctor who does better, is better, works harder, and cares more is more profitable, then by all means, YES!

What does that mean, then? If I understand the economics correctly (and feel free to correct me!), then this will lower waste and decrease cost. Technologies which are expensive but often unnecessary won't be implemented without due thought.

Where does this put those who cannot afford health care? That's the ethical quandary. If you watch the video in my previous post (mentioned above), Healthcare Crisis? Reform? What the medical blogosphere has to say, you'll see that a lot of folks don't prioritize spending. They put health insurance at the bottom of the list of spending priorities rather than nearer the top.

Other folks really do have a dilemma between eating and shelter vs. insurance and health care monies. Where will they go? In a "for profit" system, seeing them isn't profitable. What happens then? In my naive eyes, I would hope there is some charity left for them. But even if not, it looks like offering tax breaks to those who serve the indigent may be a cheaper, win-win situation for all involved. Yes, that includes Uncle Sam. Besides, it doesn't seem fair to expect charity for nothing from a tax-paying business just because it's a healthcare industry when we wouldn't do that from our auto-repair folks.

(The big question I have as I write this is how in the heck do we spell healthcare (or health-care or health care)? I've seen it written umpteen ways and even looked it up. Is there a rule? Yes, there is! Healthcare and health care are synonymous as nouns. Health-care is an adjective but may also be written as healthcare. Please don't hold me to this. I'll inadvertently err when I write.)

Comments, rebuttals, teachings, and such are very welcome. I'm all ears...uh, eyes....


  1. I don't think the best doctors are the most profitable. Those of us who take our time with the patient and really get to know what makes them tick are at a disadvantage in today's reimbursement schemes. I don't see this changing, and I don't see me changing, so I accept a lower income level and the personal satisfaction of knowing I do a thorough job.

    Overall, if we are to cover more people, we need more students to chose primary care. To do this, we either need to improve reimbursement dramatically or subsidize their education in exchange for their service, or (preferrably) BOTH.

  2. Hi, Coleen. I haven't had the chance to meet many doctors like you. (I came all the way to Pittsburgh for my adenoma removal,and went to LA to find a pituitary specialist as a matter-of-fact.) The doctors I see here are under the wing of a large organization. Very few own their own practices. Most of them are forced to sell to this big organization in order to survive due to the competition it offers. Thus, they are under-the-gun to make money. They must see a certain number of patients daily. I realize the reimbursement scheme is what influences this. Do you think it would be different if that changed, however? Or would docs still feel the need to make more money (profit) versus spending more time with their patients?

    And I like the ideas you throw out. But how do you see us bringing about these changes? Frankly, I don't think they'll happen without some outcry and strongly voiced details to the powers-that-be. If someone doesn't soon organize a way to educate the patients and get them on "this side", it won't happen.

    Just about everyone is a patient. Getting large patient groups behind PCP's seems to me a very easy task since there are already large, organized patient groups for many illnesses/diseases.

  3. 1) I think that a major fix would be to require medical providers to charge one price -- insurance, no insurance doesn't matter. It would take alot of the "value" out of the insurance industy and make medical treatment options more transparent. I fail to understand doctors complaining about insurance reimbursement. If they don't like it, tell your patients you don't take insurance. charge by the hour. If people had to pay out of pocket without insurance, trust me, doctors would get alot less than they do.
    2) I think that doctors need to views themselves as professionals again and need to get over the idea that they should be getting paid hundreds and hundreds of thousands of dollars a year. Frankly, realtors seem to me to have more collective professional pride than doctors. In my area, the big lawfirms, who receive no insurance reimbursement to prop up their payments, compete for pro bono accolades. If lawyers don't return calls to clients, it can have consequences to their license, and since lawyers can be disciplined for failure to report, lawyers do turn in their colleagues.
    3) I consult on organizational assessments and quality. The medical profession is more than a decade behind even the most backwards parts of government bureaucracy in quality assessments.
    4) as much as I dislike insurance companies, they seem to be the main entity in the medical field researching and pushing for practice improvement.



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