The Pressures on Doctors for Profits

You have to watch this short clip from a video called Health, Money, and Fear, produced by an emergency room (ER) doctor.
Chapter 6 is about the pressures on doctors to maximize profits.
Go to: www.ourailinghealthcare.com , then Play Chapters, and select Chapter 6.

ER doctors describe the pressures placed on them to produce more of what are called RVUs or units of billable activity. They are encouraged to order expensive diagnostic tests like CT scans or MRIs in order to bring in the big bucks and, at the same time, reduce their risk of liability.

Because a business model has replaced the earlier patient care model, doctors now find themselves in a bind. Should they approach the care of their patients with tests and procedures which are quick and add lots of RVUs and money OR should they focus, instead, on patient education about exercise and diet which takes much more time but yields little in the way of billable hours?

More on Canadian Health Care

Robin wanted to look at the fear that some have about Canada's 'socialized' health care system. She found a useful article by Rhonda Hackett from June 2009 in The Denver Post addressing myths about Canadian health care. http://www.denverpost.com/opinion/ci_12523427
Hackett is a Canadian who has been living in the U.S. for the past 17 years.

Here are 3 of the myths and some of the arguments she brings to bear in debunking them.

1. The Myth: Canada is a socialized health care system in which doctors work for the government.
The Reality: Doctors work in the private sector - most are self-employed - while their pay comes from a public source.

2. The Myth: There are long waits for care, and this compromises access to care.
The Reality: There are no waits for urgent or primary care in Canada. There are some waits for specialists' care and longer waits for elective surgery.

3. The Myth: Canada's health care system is a cumbersome bureaucracy.
The Reality: In the U.S. 31% of every dollar spent on health care goes to paperwork, overhead, CEO salaries, and profits. Canada operates with just a 1% overhead.

We attended a health care reform forum this week

We attended a health care reform forum this week. One of our local chiropractors has been hosting a series of what he calls transformational dialogues, and this was one of them. Nice idea. Rather than a battle between supporters and opponents of health care reform, the focus was on encouraging a thoughtful discussion about the important questions that need to be asked. Dr. Craig posed questions for the panel which included doctors, nurses, anthropologists and a health care policy advisor.

A few of the issues raised included: health care as a right vs. a privilege, how to reduce health care costs, how much profit should be involved in health care, and what drives the intense feelings on both sides of the issue.

Here are a few points that were made in addressing these issues:

• Canada spends half of what we do. We are ranked #37 and Canada is #3.


• A study in the New England Journal of Medicine of 6000 physicians representing every specialty reported 63% in favor of a strong public option, an additional 10% in favor of single payer. 


• In the 60s, the American Medical Association (AMA) fought hard against Medicare. The AMA represents only 25% of physicians. 


• Pharmaceutical companies spend only 13% of their money on research. They rely a great deal on government funded research.


• Only two countries in the world allow advertising of medications on television - the U.S. and New Zealand.

The Chaos of Health Care Reform

Well folks, it has been quite a ride since we last visited our blog and the issue of health care reform. The process of "discussion" of options and plans has been chaotic and downright nasty. We are interested here in looking at the big picture. In the course of traveling that route, we have come across some very thoughtful articles that address various pieces of the puzzle. One of those pieces is the cost of health care and how to control it.

One article that we especially like is called 'The Cost Conundrum' by Atul Gawande. It appeared in the New Yorker in June 2009.

Here's the link. http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

The author looks at the costs of health care in the U.S. He searches for the places that spend the most money on health care as well as those that spend the least. McAllen, Texas turns out to be one of the most expensive towns in the U.S. for health care. He also looks at models like the Mayo Clinic, which operate in various parts of the country, and Grand Junction, Colorado, a community which provides high-quality health care at substantially lower cost.

What accounts for the differences? After a great deal of digging, interviewing and comparing, he points to one particular issue and dividing principle. Rather than trying to maximize profits for the practitioners, the leading doctors and the hospital systems in the lower-cost places have found ways to reduce or eliminate incentives to spend more for the sake of maximizing profits. They also take collective responsibility for improving over-all patient care.

There you have it - one piece of the big puzzle. It is not easy to change an underlying philosophy and approach to patient care, but it has clearly happened successfully in some places and could be replicated and save lots of money without compromising quality of care.

Health Care Reform

We have attended a couple of forums and are learning about the bills currently being proposed in the House and the Senate:

HR 676 (Representative John Conyers) - U.S. National Health Insurance Act: Expanded and Improved Medicare for All Act

S 703 (Senator Bernie Sanders) - American Health Security Act of 2009

HR 1200 (Rep. Jim McDermott) - American Health Security Act of 2009

Here is a good link for tracking federal bills: http://www.govtrack.us/

Here is one more link to get good up to date information on health care reform:
http://www.pnhp.org/
This is the website of the Physicians for a National Health Program.