How to Fix Health Care: Four Weeds to RemoveBy Dr. Scott Haig Thursday, Apr. 30, 2009Dennis Degnan / Corbis
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Scores of agencies police doctors. Thousands of people make their living doing it. They give us yearly tasks that doctors, on pain of ending our careers, absolutely must do: 10-page re-appointment forms, written exams, blood tests, physicals. Every hospital we work in, every HMO we sign up with, does this too. Every year. Every 10 years we have to take our Boards again (Imagine if lawyers had to pass the bar exam again, every decade until they quit.) And there are yearly federal and state licensures and safety exams, fire exams, infection control exams, malpractice insurance exams, queries about crimes we're assumed to have committed and disabilities we must prove we have not developed. (See the top 10 medical breakthroughs of 2008.)
Of course we need to know our doctors are healthy and competent. But the system now is redundant and takes up way too much of our time. Many doctors believe that it's largely for the benefit of the regulators themselves. A unified federal credentialing agency could pull those weeds right out and leave the country with five to ten percent more doctoring at almost no cost.
From where we sit (and doctors think we are the ones who are in the best position to know what malpractice means and when it happens) there is little or no correlation between doing bad stuff and getting sued. We also observe that none of the countries whose medical systems are held up to us as better than ours have any malpractice system at all. And that the cost of defensive medicine is enormous — much higher than published estimates.
We're also much less likely to do charity work when we can lose our houses in the process. This last is a serious problem for the uninsured; most doctors are pretty decent folk who actually like what they have spent their lives learning to do; they really wouldn't mind doing some free work. As a group though, we tend to be quite risk averse. We worry about the downside — it's where we live. Our insurance premiums can be crushing: it's $240,000 a year for a neurosurgeon in New York now. One way or another that's an expense that gets passed down to all. Can our country afford this luxury at this time? Want more medical care for less money? Get the lawyers out of our garden, and find a better way to sanction bad practices without damaging everyone.
The Medical Billing Industry:It costs the typical doctor about 10%, right off the top, to collect our fees from the HMOs and other insurance companies we have to deal with. This is due to the ultra-complex set of rules and regulations those companies have established to "control costs" (read: to pay us less while their executives take home more) and the billing staffs we have to hire to deal with them. This money does nothing for patients; it's a healthcare expense that produces no healthcare. It could easily be eliminated with simple, intelligent, centralized payment rules. The result would be at least 5% more care for the money.
It's a complex topic that boils down to this: if we who do the medicine thought more computers would save us money we'd buy them ourselves. In fact, sometimes we do. But the federal mandate to computerize and centrally connect the entire country's medical records has little chance of saving money for anyone except the lucky insiders who sell the computers, software and support. Aside from their costs to us, electronic records are time consuming — a constant distraction from patient care. They also put doctors on a slippery ethical slope; it's pretty easy to bill more for the same services with a good EMR program. They are a dangerous weed being advertised as fertilizer.
There are others: our byzantine system of Continuing Medical Education, medical advertising, the HMOs themselves and our top-heavy system of hospital administration to name a few. More on these during growing season.
Wednesday, April 29, 2009
How to Fix Health Care: Four Weeds to Remove - TIME