Category: Physician Autonomy

Exhausted

From a note on my patient’s chart today:

Dr. _______
Mrs. ________ has exhausted her SNF [Skilled Nursing Facility] coverage. She has used her full 100 days and does not qualify for Medical Assistance [Medicaid]. She would have to privately pay for an SNF and she cannot afford this.

Doctor’s Reply: What can I do about this?

Response: The patient and family are aware and husband says he will hire help but cannot afford private pay at SNF.

France’s model healthcare system – The Boston Globe

France’s model healthcare system – The Boston Globe:

“National health insurance in France stands upon two grand historical bargains — the first with doctors and a second with insurers. Doctors only agreed to participate in compulsory health insurance if the law protected a patient’s choice of practitioner and guaranteed physicians’ control over medical decision-making. Given their current frustrations, America’s doctors might finally be convinced to throw their support behind universal health insurance if it protected their professional judgment and created a sane system of billing and reimbursement. French legislators also overcame insurance industry resistance by permitting the nation’s already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Sécurité Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market.”

I think that, except for the hard core ideologues, physicians would by and large accept this bargain.

WSJ 2006 “The Doctor’s Office” on Single Payer

Government-Funded Care
Is the Best Health Solution

Multiple Insurers, Multiple Plans
Create Expensive, Draining Hassle
April 18, 2006:

“Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.
The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.
The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there’s $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system.”

It’s so obvious that it hurts.