Dr. Rob from Musings Of A Distractible Mind has written a great article about preventive medicine and how it’s become a political issue, with candidates talking about lowering health care costs by preventing diseases before they occur, or catching them in their early stages. Dr. Rob sees it differently, and in reality I’m sure that the politicians’ advisers do too, but embracing preventive medicine makes a candidate more popular, even if the eventual result will be increased health care costs. There are a couple ways to view preventive medicine. There’s the high-dollar testing and screening (think MRIs, bone density testing, colonoscopies, etc.), and then there’s basic preventive medicine that involves working with patients to get them to eat right, exercise, maintain a healthy weight, avoid smoking, etc. The former are easier to bill to health insurance companies, but the latter are much less expensive. Dr. Rob maintains that primary care physicians, when compared with specialists or emergency room docs, are much more likely to treat patients without the use of extensive costly screening tools. And I would add that primary care doctors – since they see the same patients over and over – are in a better position to help their patients develop habits and behaviors that will prevent disease in the long run.
But primary care physicians are not flocking out of the doors of our nation’s medical schools these days. The Happy Hospitalist has written an article about the nitty gritty of doctor reimbursement that explains with simple dollars and cents math why medical students are attracted to specialties (I was unaware of the finer points of physician reimbursement before I read this article. Could the powers that be possibly make this system any more complicated?). And as Dr. Rob pointed out, specialists are more likely to order high-dollar screening procedures as soon as a patient arrives in the office. Preventive care, yes. But it’s expensive preventive care.
Obviously the orthopedic surgeon who operated on Jay’s knee in January (and again on the other knee earlier this week) has a very specialized set of skills and is well-compensated for what he does. But the family practice doctor who sees our son for his well-baby check ups (and who will see him if and when he ever needs medical care beyond well-child checks) is also performing a vital service. But based on the EOBs I get from our health insurance carrier, a hour of her time is worth significantly less money. Even though she has the ability to influence our son’s health throughout his childhood, whereas the surgeon is only participating in my husband’s health as it pertains to knees (although I must say, he’s done a fantastic job). There’s definitely a flaw in the way our health care system reimburses for care, and the article from the Happy Hospitalist gave me a glimpse at it. Obviously some specialties have higher malpractice insurance premiums and higher overhead, and must therefore be reimbursed at a higher rate. But when we remove those factors, physicians should be compensated based on experience, hours worked, and outcomes, rather than the number of specialized procedures performed. Maybe then primary care would be a more popular choice for medical students, and preventive medicine wouldn’t have to be such a budget-buster for the health care system.
Thanks to Notes From An Anesthesioboist, where Grand Rounds was hosted this week, and where I found the articles from Dr. Rob and the Happy Hospitalist. The Colorado Health Insurance Insider article about tax credits for health insurance was also included in the Grand Rounds.
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