Sunday, February 24, 2008

Health Care, Through a Patient's Eyes

As Stephanie Ramage sagely points out, the clamor for universal health care is almost meaningless as long as the level of care is not diminished.

On this, we will agree.

However . . .

In part 1 of a 3 part series, Stephanie refers to a recent study by the Kaiser Foundation and USA Today where "52 percent said universal health insurance coverage would have no effect—for better or worse—on the quality of the health care they receive."

So IF we achieve universal coverage (unlikely even under the most liberal proposals) and IF we are able to make health care affordable (even more unlikely with all popular proposals) what good is that if the quality of care is diminished?

Quality of care, especially when gleaned from patient interviews, is subjective and questionable at best.

Those who were disappointed in the outcome, regardless of the circumstances, will almost invariably say that quality of care was substandard.

Those who were pleased will praise the quality of care.

That being said, let's look at some key issues raised by Sunday Paper.

In places like Atlanta, we may have too many specialists in proportion to a relatively small number of general practitioners. Then there’s the crushing shortage of nurses.

A shortage of PCP's (primary care physicians) is not indigenous to Atlanta. In virtually all metropolitan area's the same can be said.

The reason for this is pure economics.

For the most part it costs almost as much to educate a general practitioner as it does a specialist. The staggering debt of medical school is only slightly less than the debt incurred by a surgeon.

However the earning power of a surgeon is several times higher than that of a PCP.

A family practitioner will earn (on average) around $204,000 per year while a cardiovascular surgeon will earn around $558,000.

If the cost of medical school is the same and the only difference in training is the additional years in residency (a paid position) then is it any wonder that med school grads are shunning primary care in favor of the specialties?

Another so-called fault of the U.S. health care system is the dearth of E.M.R. (electronic medical records). Sunday Paper points out " doctors in the U.S. are far less likely than their counterparts in other developed countries to use an electronic records system that would allow them to see their patients’ histories with the click of a button, saving their patients a lot of hassle and saving the system a lot of money by not duplicating tests."

One reason for this is government intervention.

I can't speak for other countries, but in the states PHI (protected health information) is considered almost sacred. Your medical records are supposed to be a closely guarded secret that can only be shared with others with your written consent. The problem with EMR. is, how do you keep the records safe from prying eyes yet make the information available to those who need to know.

HIPAA (which governs PHI) is an onerous bill with severe fines and even imprisonment for those who violate your rights. We are gradually moving toward EMR but the move is not quick enough for most.

we can fix our system’s quality problems, and med schools and professionals all over the country are already taking the first steps toward doing exactly that—but to do that, we’ve got to make patients the center of our health care system.

Patients (and their care) ARE at the center of the health care system but at the same time we must recognize that patients are not paying the bills. When 85 cents of every dollar spent on health care comes from third party payors (government plans, insurance carriers, etc.) they have some degree of influence on the type of care given.

When patients pay the lions share of the bill they can and do have more say in their level of care. This is particularly true with concierge services.

All in all the article makes an impression but relying on subjective data to form an opinion is risky at best.

I do look forward to parts 2 & 3 of Stephanie's report. It will be reviewed and dissected on this blog.
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