Health Care

The Tribune carried a guest editorial this morning from Dr. Mike Dube, a local orthopedic surgeon. (I cannot locate it online; I will excerpt certain portions.) I know, respect and like Dr. Dube, so I mean no personal disrespect or affront. (In fact, I know many individuals involved in health care so, please, accept this for the discussion it is and don't be too defensive.)

But a couple points did jump out at me.

First, one of his complaints centers around utilization review. In very general terms, this is the process by which health insurers review the procedures ordered by doctors to determine whether those procedures are covered by the health insurance policy. A common inquiry is whether the procedures are medically necessary. I will agree with Dr. Dube that this is an onerous process, and detracts from the provider's ability to serve his or her patients. (In other words, there is only so much time in a day, and if a physician is on the phone wrangling with an insurance company, that is time he is not spending with his patients. This applies to many different scenarios.)

Dr. Dube then goes on to discuss the concept of "defensive medicine." He is referring to the fact that, in this age of lawsuits, physicians will take steps that are, perhaps, medically unnecessary in order to protect themselves from a lawsuit: "Physicians order many more tests than they normally would to cover all the bases in case a patient comes back at them with a lawsuit. Many times these tests have a low yield and would add little to the treatment plan."

Is there a contradiction here? If a physician orders a test that "would add little to the treatment plan," and he or she does so to protect himself or herself from a lawsuit, why should the patient's health insurer have to pay for that test? Hasn't Dr. Dube in fact offered a real justification for utilization review?

Dr. Dube also discusses the high cost of health care as being driven by the cost of the materials used by physicians. He says we need to control this: "Pharmaceuticals, medical supplies, and implants need to be controlled. Large corporations can no longer be allowed to exploit the system and reap astronomical profits at the expense of the patient. This will cause the cost of medicine to decrease."

Dr Dube eliminates from consideration the personnel costs involved in the delivery of health care with a single conclusory statement: "Physi­cian reimbursement is not the driver of soaring costs." Is that true? I don't know.

If we proposed to cap physicians' incomes, my guess is that Dr. Dube might disagree with such a proposal. Yet his solution demonstrates a willingness to cap the income of others. He would no doubt suggest that capping physician incomes would worsen the present situation where the "best and the brightest...no longer want to practice medicine and the quality of care will suffer."

What will capping income do in the pharmaceutical and prosthetics industry?


WolfPack said...

I too thought Dr. Dube's piece was a little self serving. According to him cash patients are the most efficient for him to provide services to (no third party oversight or paper work hurtles), yet unless he is different than other physicians he charges cash patients more than those with insurance. Why do doctors charge cash patients more? I would guess it is no more complicated than because they can. Does this make Dr. Dube as bad as those dastardly pharmaceutical companies he railed against?

I would also venture to say that physicians shoulder some of the blame for the rising costs of medical materials. The doctors specify the materials but do not pay the bill and therefore are not highly motivated to seek out the cheapest acceptable solution. This leads to an economic disconnect and perverts the supply/demand curve wherein the consumer and the supplier are insulated from each other by a third party. The insurance company’s intervention buffers this defect by limiting the amount paid for medical supplies.

I do not fully agree with Geeguy on defensive medicine not being a factor in the medical inflation equation. Of course the insurance companies should pay for the doctors CYA as long as it is within limits. All costs of doing business are eventually paid for buy the consumer or his insurance company. This includes steps necessary to keep the lawyers at bay.

david said...

Just about every aspect of the healthcare system is wrong...the only solution is a return to TRUE fee-for-service care, with insurance only needed and used for inpatient care and catastrophic stuff.

Sadly, it won't happen in our lifetime...

pediocetes said...

The piece is self serving. The reason cash patients are charged more is that physicians and hospitals have made deals with, or are forced into, (Medicare reimbursement structure too complicated to comprehend) charge "adjustments" from the big payers, private and government insurers. The poor guy paying cash gets the "unadjusted" bill. One more reason for some "universal coverage" plan, but paying for it will have the politicians running for cover. Most health care providers would be in favor, but the Democratic party would not be able to support because universal coverage would have to include some time of tort reform, with mediation of unexpected outcomes. And guess who would be against that?