Thursday, July 26, 2007

what your doctor is really thinking

I read a lot of blogs written by doctors. It's a fascinating read. I understand now why US doctors are in such trouble. There are laws in the US that state that anyone who goes to the ER must receive treatment. Now in theory that sounds wonderful right?
There are three kinds of people that go to the ER: Medicare/Medicaid, HMO or other insured and the uninsured. Medicare/Medicaid have set reimbursement rates. Your ER doc can treat you for an acute MI(heart attack) that can take four or five hours and use incredibly expensive medications and even more costly interventions.
The doc will then bill Medicaid. Say he bills $5000 for the whole thing.. well Medicaid/Medicare can reimburse them as little as $500 for the complete care of a heart attack. HMO's base their reimbursement rates on Medicare/Medicaid reimbursement rates with a tiny increase. Maybe the doc gets paid $1000. The uninsured get billed the whole $5000 and they are expected to pay it. Of course they never pay so the doc must eat that loss.
Remember most docs are not hospital employees. They work on contract and are bound by fee for service reimbursement. Meaning they don't get paid until the insurance provider pays up.
And we all know how efficient and cheerful insurance companies are. Though most docs will say the government program pays reliably, they also don't pay very much at all.
Can you imagine having to sit around and hope that your pay check will resemble even remotely what you expect?
And that the work that you do no matter how difficult or time consuming will never be reimbursed?
What incentives are there for any doc to keep working in the ER?

Worse George Bush has decided he will veto legislation that continues health coverage for 4.5 million children. George says why should they care is available to everyone in the US."just go to the emergency room".
Yes, the President of the United States is as dumb as the proverbial rock. There is actually a reason the word EMERGENCY is used when describing the ER. Getting your vaccinations so you can start preschool isn't an emergency but George Bush thinks it's just fine to bring 4.5 million children into the ER for well baby check ups and vaccinations, ear infections and common colds. According to the decider poor people shouldn't get the health care he gets. Even more brilliant? George, in his enviable wisdom didn't bother to figure out who would be responsible for paying for all this brand new "heath care". It has been left unfunded.

It has crossed the minds of hospital administrators who realize their hospitals will sink into bankruptcy if they have to absorb the costs of caring for 47 million uninsured US citizens or uncounted non citizens.
Did it never occur to anyone that hospitals actually have to pay for the supplies and drugs they use? They have to pay the staff that work there. They have to get the money from somewhere right?
Well have a look at your HMO premiums. You are beginning to pay for the new onslaught. HMO's will agree to higher reimbursement rates to keep the hospitals afloat as long as they can jack up the premiums and keep the shareholders happy.
And by the way what kind of sick bastard do you have to be to own shares in a HMO? Making money from disease and death but offering nothing to the suffering.

In Canada we have a same but different problem. We have a set schedule fee for service. It sucks. Which causes family docs to see an army of patients every day so they can pay their mortgage and the office costs. The doc always gets paid, there are no uninsured but the reimbursement ain't much. You aren't going to get rich being a family doc so no one wants to work in primary care. We have a shortage of family docs because it is hard work with not great pay. I do have to qualify this by saying not great pay for them $100,00-$200,000 a year would be hitting the lottery for a lot of us so let's not be all that sad . But we do have to remember docs incur a ridiculous amount of debt going to med school, sometimes up to $100,000. That is one hell of a student loan that has to be repaid.

And to bust the myth about wait times in Canada, they aren't any different than a Medicare/Medicaid patient in the US. Sixty percent of all insured US citizens are covered through these two programs...60%.....They are already enrolled in a Canadian system of health care but everybody pretends it's not. This system has all the same problems we have, waste, fraud, lengthy wait times but we don't have the biggest problem...a majority of US docs refuse to care for patients on Medicaid/Medicare.
So, you have insurance but you can't find a doc willing to look after you so what must you do?
Go to the ER..the President said it was okay.


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