answer to how to increase access to healthcare

[newdude]

i think the biggest problem in healthcare is access and i wanted to know what fellow SDners think is the best way to fix this problem

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[newdude]

i think the biggest problem in healthcare is access and i wanted to know what fellow SDners think is the best way to fix this problem

bump

 

[MarzMD]

More primary care physicians willing to work in underserved areas. Possibly some sort of universal healthcare plan. However, only if cost of healthcare is able to be significantly cut through better public health and primary care physicians practicing preventive medicine.
It might be better to post your answer to the question so that people can respond to the pos/neg of what you are thinking.

 

[jebus]

More primary care physicians willing to work in underserved areas. Possibly some sort of universal healthcare plan. However, only if cost of healthcare is able to be significantly cut through better public health and primary care physicians practicing preventive medicine.

Can't we reduce healthcare costs like every other industry does? By outsourcing? And not just medical care, but typists, receptionists, etc.? Isn't it about providing healthcare, not necessarily keeping jobs in America? And by outsourcing, don't we open up new niches for Americans to exploit, anyway? So outsourcing doesn't become that big of a threat...
http://www.timesofoman.com/newsdetails.asp?newsid=22310
http://www.thehindubusinessline.com/2005/11/21/stories/2005112102820500.htm
http://www.earthtimes.org/articles/show/4505.html
http://www.cambridge-news.co.uk/news/city/2005/11/24/ce1173cf-a522-48d3-989f-d24ca40b27e0.lpf

 

[MarzMD]

Can't we reduce healthcare costs like every other industry does? By outsourcing? And not just medical care, but typists, receptionists, etc.? Isn't it about providing healthcare, not necessarily keeping jobs in America? And by outsourcing, don't we open up new niches for Americans to exploit, anyway? So outsourcing doesn't become that big of a threat...
http://www.timesofoman.com/newsdetails.asp?newsid=22310
http://www.thehindubusinessline.com/2005/11/21/stories/2005112102820500.htm
http://www.earthtimes.org/articles/show/4505.html
http://www.cambridge-news.co.uk/news/city/2005/11/24/ce1173cf-a522-48d3-989f-d24ca40b27e0.lpf

Wouldnt that reduce physician salary and autonomy even more?

 

[jebus]

Wouldnt that reduce physician salary and autonomy even more?

That's my point, but wouldn't reducing cost help improve access - the OPs original point?
The world's growing fast, and if you don't want a job, for every one of you there are dozens of people in China and India who will want it.

 

[DrBowtie]

That's my point, but wouldn't reducing cost help improve access - the OPs original point?
The world's growing fast, and if you don't want a job, for every one of you there are dozens of people in China and India who will want it.

As you said, there are many ways to improve access.

Whether or not they are in physicians best interest is what is questionable.

 

[Mr. Freeze]

Newdude, instead of soliciting opinions to answer whatever you're trying to answer, surely you have some of your own?

You can't start a fire just by lighting a match; you gotta throw a little wood on too...

Although now I see someone beat me to this line of thought, it still stands...

 

[newdude]

Newdude, instead of soliciting opinions to answer whatever you're trying to answer, surely you have some of your own?

You can't start a fire just by lighting a match; you gotta throw a little wood on too...

Although now I see someone beat me to this line of thought, it still stands...

hey

my answer is basically to provide better info. to everyone, if you are informed then you will use the service. i didn't think people would get on my case for asking their thought.

 

[Jon Davis]

Asking for universal health care is damn near scary in the US. You remember FEMA in Sept. 2005, the destruction of social security, the state of Medicare and Medicaid? I have little confidence that it will work in the US. That being said, there must be more stringent price controls on the rising costs of health care. At this rate, average Joes can barely afford basic care.

I don't really have a good approach to solve the access problem but to impose price controls.

 

[Jon Davis]

Newdude, instead of soliciting opinions to answer whatever you're trying to answer, surely you have some of your own?

You can't start a fire just by lighting a match; you gotta throw a little wood on too...

Although now I see someone beat me to this line of thought, it still stands...

Very true. There have been a few "firey" threads started by "unkowns" here in this forum. My question is why are these people doing this? They put up a stupid post to elicit fury only to cut and run later on.

 

[deleted77919]

I feel like, if anything, setting an artifical price ceiling will restrict, not enhance, access to care. If the price is artifically low, then fewer people are going to be willing to provide those services.

However, I also feel like the supply of physicians is currently artificially restricted because of the lack of expansion in the physician work force compared with the growth of the US population. I think if we opened some more medical schools and increased the supply of physicians, including more incentives to work in primary care (prevention costs less than intervention) that would be a good start.

 

[MarzMD]

Asking for universal health care is damn near scary in the US. You remember FEMA in Sept. 2005, the destruction of social security, the state of Medicare and Medicaid? I have little confidence that it will work in the US. That being said, there must be more stringent price controls on the rising costs of health care. At this rate, average Joes can barely afford basic care.

I don't really have a good approach to solve the access problem but to impose price controls.

Thats exactly my point. Universal healthcare would be a disaster in the US unless cost of healthcare was reduced to the point that it was more affordable. Also, there would have to be a huge leap in preventive care in order to combat the masses of people that would then flood doctor offices if we had a universal healthcare system. And like the OP said, better education to the consumers. Now, this will not happen any time soon, if ever, but it is a solution to the problem that would make everyone happy.

To desiredusername: Yes, that would reduce cost. However, as a future physician, I do not see this as the ideal solution.

I think Shredder had a thread a while back that was relevant to this question. I would suggest finding it.

 

[newdude]

Very true. There have been a few "firey" threads started by "unkowns" here in this forum. My question is why are these people doing this? They put up a stupid post to elicit fury only to cut and run later on.

i have over 200 posts, so chill.
i posted the question b/c i normally say/have said, access w/o thinking about how to solve it. i think it never came up.

 

[gdbaby]

Maybe there is some way to do the equivalent of the "sick pool" at people's jobs: people who know they won't be using all their sick days can throw them into a "pool" so that if someone else becomes really ill or needs family leave, they can dip into this pool.

So, most health insurance companies allow for X number of visits, hospital days, etc. If you are a normally healthy person, you could give back a few days to the "pool" to allow others with no insurance access to care. Think of how much money would REALLY be saved if people were allowed to receive routine, preventative care. But the US tends to be a reactionary society, not a proactive one.

Of course, there are issues here because, like when airlines oversell seats hoping people don't show or reschedule, health insurance companies are currently relying on the fact that you WON'T use all your days. I think the interviewers at med schools just want to know that you are thinking about these issues and that you are able to see many sides of an issue--not that you will solve the problems in medicine during your 30 minute interview. At least I hope so.

 

[stoic]

to the OP, do some research and make up youir own mind about the access to health care issue. if you look at any depth you will soon find that the problem is so enormous and complicated that you'll soon want to pull your hair out.

i'll tell you this much, just providing better information to people with the hope that they will more efficiently use the healthcare system is probably not a good answer. why? because their is a huge portion of the population that can't access care even if they were only trying to do so only when they actually needed to go to the doctor.

i'd look more into the factors that contribute to the prohibitive cost of medicine these days. for example, cost of service is increased to compensate for those who can't/don't pay their hospital bills. but raising cost just prices more people out of the system in the end. also, the cost of care out-of-pocket is much higher than what insurance companies medicare/medicaid end up paying for the services. so doctors raise their prices to collect more from the insurance companies who generally pay a percentage of what medicare pays for a visit/procedure. this leaves those without insurance up **** creek, because now an MRI cost $2,000 out of pocket... even though insurance will end up paying a fraction of that cost through negotiated fee schedules. this is why is completely unfair to say the problem lies with consumers for not paying bills... the bills are artifically inflated!

of course the increasing prevelance of technology in healthcare is also very expensive. helping clinicians, not patients, properly use these technologies could probably help costs. of course, most clinicians know that everyone with a headache doesn't need a CT scan.... but if you're covering your ass cause you're afraid of getting sued you're probably gonna order it anyway.

and don't forget about the cost of pharmaceuticals. as younger, healthier people we often overlook this... but no one should be paying hundreds of dollars a month for medicines. and many, many people are. including my fiancee and myself for relatively common, chronic conditions. we've got insurance and it still taxes our budget. in fact, we both needed MRI's earlier this year and it ended up costing so much even AFTER insurance that we've cancelled our ski trip and pushed back our wedding.

the current health care system is stressed to the MAX. make no doubt about it. i'm hardly in the "system" at all as an MS1, but the problem is so enormous that it's impossible to ignore. in the coming years you will honestly not believe how your perspective and knowledge about the issue grows.

universal healthcare is something that will happen within the next 20 years, if not sooner. it MUST because the system simply cannot survive without it.

*********

the bottom line with this question, which you will get at interviews, is that they are looking to see if you really understand the issues. obviously there isn't one right answer; if there was they'd have instituted it by now. don't be afraid to engage your interviewer in a dialouge on the topic, it's something that they'll have a lot to say about.

 

[Cram]

My opinion:
I think two problems need to be addressed. 1st: providing (paying for) care for uninsured above the poverty line. 2nd: make going to the doctor easier/ less painful.

Problem 1: Cut/consolidate the most wasted and abused problems. Restructure Medicare so that those >65 with incomes can once again use private insurance. Tighten (reasonably) draining of assets to relatives to obtain Medicare provided nursing home care, etc. Vigorously pursue improvements in quality management (good care is preventative, bad costs more) and improve bureaucratic efficiency. Privatize/streamline administration as needed.

Problem 2: Bring management of physician practices out of the dark ages. Simplified national coding/billing. Basic National electronic med records standards, still allowing competition in solutions. End Goal: 1 doc, in the process of talking an exam (and making basic e-notes) creates automatically all of the related billing, medicare, and patient records. Next: eliminate the waiting: Practices use streamlined, thoughtful, same-day appointments, same day referral, testing ,and follow up. This applies first to public health care (county, Medicare, etc.)

Fixing the patient experience will pay for itself in great compliance increases, and improved efficiency. Private practice mgmt companies should compete to administer the public testbeds. As improved technology and experiences trickledown to the private sector, public support will increase.

(Can you tell i'm sick and bored out of my mind!?)

 

[Cram]

Two other glaring problems to reduce expenses:

1. Rewrite the tax/non-proffit/ billing laws so that hospitals can bill at actual cost + 10% or cost+profits . Currently, they are required to balance the books by basically splitting all overhead (research/loss /charity costs)between paying customers. Hence the $50 asprin. How would you reduce household expenses if you recorded fake costs for each item ? Reduce unnecessary paperwork, the need to keep multiple versions of accounting records etc. None of this contributes to care, just attorneys and accountants.

Truth in accounting would make efficient use of funds, (Pham etc) much easier. Capitalism doesn't work with bad information.

2. Promote prevention via pocketbooks ( and maybe access). Give discounts to those that go to suggested checkups, screenings, vaccinations (on time). Reward compliance. Discount for attendance at group preventative health education. Some healthful habits (exercise, not overeating, excessive smoking, drinking, drugs) can be detected medically. offer insurance discounts to those complying. offer transplants, and elective surgery to the healthy first, waitlist or increase cost (?) for others.

 

[Shredder]

open the floodgates for doc supply. the AMA cartel has to be busted, too many politics and special interests at the expense of patients and prospective premeds (borderline ones especially), and to the benefit of current docs (fortifying their positions). ive had about enough of the govt "protecting" citizens. someone mentioned FEMA--it goes to show how effective public sector regulations and actions are. hopefully the medical tourism industry will take off and american docs will see that it's futile to limit themselves once borders are lowered. just like IT sector and GM 30k layoffs. americans cannot get away with complacency in this century. in summary, more docs->better access. seems intuitive to me. competition=yes

in the end free markets will always find a way to win, even if it requires revolution or deaths (from war or bad healthcare). as history has demonstrated.

 

[Em1]

There already have been good increases in the numbers of primary care PAs and NPs to deal largely with minor and preventative stuff. They increase access and don't cost as much to the pt, which I think is fabulous.

Something needs to be done about the 45 million uninsured. Maybe raise the min. income to qualify for Medicaid? However as a future physician I'm concerned about the gov't getting too much control over physician salaries... they're already planning to significantly cut Medicare physician payments starting next year. (also bad for pts b/c some portion of doctors will refuse to see them)

 

[Cram]

open the floodgates for doc supply. the AMA cartel has to be busted, too many politics and special interests at the expense of patients and prospective premeds (borderline ones especially), and to the benefit of current docs (fortifying their positions).

Do you think the AMA is really the limiting factor? I've always agreed with that, but recently, I've come to believe its really the nature of govt funding for higher education that is the real impediment. Ex: texas' new El Paso school: AMA/AAMC approved, Texas approved, but lost legislature support ( for now).

I imagine if you ask any public school why they don't increase size, the answer is financial. Probably similar for private. when did the last private MD school open? If the future is in public schools, popular support has to be there. Right now its a non-issue.

 

[Cram]

open the floodgates for doc supply.

Supply is an issue, as demonstrated by the wait time (months) to see many specialists.

However, prices are already largely fixed. I doubt MD supply would alter that much. Furthermore, given the near 0 real increase in Dr. income and supply over the past 15+ years, and the wild increase in medical expenses -I don't see how Dr salaries could be the problem.

 

[DropkickMurphy]

I'm all for handing off the primary care stuff to FNP's and PA's. They are comparitively cheap, relatively easily trained and highly competent alternatives to physicians for those non-challenging cases that mark primary care. This way physicians would be left available to take care of "real" patients (read as those with highly complex or involved cases), not just those who need immunizations and routine meds.

 

[jebus]

open the floodgates for doc supply. the AMA cartel has to be busted, too many politics and special interests at the expense of patients and prospective premeds (borderline ones especially), and to the benefit of current docs (fortifying their positions). ive had about enough of the govt "protecting" citizens. someone mentioned FEMA--it goes to show how effective public sector regulations and actions are. hopefully the medical tourism industry will take off and american docs will see that it's futile to limit themselves once borders are lowered. just like IT sector and GM 30k layoffs. americans cannot get away with complacency in this century. in summary, more docs->better access. seems intuitive to me. competition=yes

in the end free markets will always find a way to win, even if it requires revolution or deaths (from war or bad healthcare). as history has demonstrated.

Opening the gates, as you say, may also provide not only better access for americans but also better care. In my experience, physicians from developing countries are much better at rural care than American educated physicians. Chances are they'll also work cheaper than their American counterparts, and highly educated peoples from south and central america are often fluent in 2 languages.
But I don't think the problem lies only with the AMA, to open the floodgates you'd need to increase the number of H1B visas the US grants. We've already seen problems with this - even Bill Gates told a summit of American governors this past April that that American workers just can't compete with foreign trained ones (if you subscribe to NYTimes Select, you can read all about it in Tom Friedman's April 29, 2005 Op/Ed piece) and he's going to have trouble importing workers so why not make their Bangalore campus bigger? - and with increasing border security scrutiny, we aren't going to see much movement there anytime soon.
More doctors = better access, but the trick is to show doctors that outsourcing, etc., will open up new niches and can improve their bottom line. But you've got to plan ahead; you don't wait until the problem is staring you in the face, you prepare for it decades in advance.

 

[TX515]

1. Some folks rely on the ER as their primary level of care, and that is not good. This has some part due to financial strain. Healthcare is expensive, and I think approximately 1/4 of Americans do not have any health insurance. If the health care is delivered cheaper, more people will take advantage of the treatment.
2. Some folks do not have adequate treatment available. All of the medicine is in bigger cities. There needs to be more health care professionals dispersed across our nation, not just concentrated in a few cities.

 

[Shredder]

Do you think the AMA is really the limiting factor?

i think it is all AMA protectionism and motivated by either money or power plays, as with just about everything. there need to be unemployed docs, that is when access will be where it needs to be

 

[stoic]

i think it is all AMA protectionism and motivated by either money or power plays, as with just about everything. there need to be unemployed docs, that is when access will be where it needs to be

oh give me a break. we have more docs per capita in this country than just about anywhere in the world, including places that spend a far smaller percentage of the GDP on healthcare AND who have healthcare outcomes similar or great to ours. what we really have is a shortage of physicians who take medicare or will see the uninsured.

 

[little_late_MD]

oh give me a break. we have more docs per capita in this country than just about anywhere in the world, including places that spend a far smaller percentage of the GDP on healthcare AND who have healthcare outcomes similar or great to ours. what we really have is a shortage of physicians who take medicare or will see the uninsured.

To add to this, I believe that we are actually in the top 3 in terms of doctors per capita (I saw a table of this a week or two ago, but I can't recall where). However, we far and away spend more dollars per capita on health care than any other country. Last figures I saw put our per capita rate at three times that of Canada.

 

[DropkickMurphy]

what we really have is a shortage of physicians who take medicare or will see the uninsured.

There's a good reason for that. Not that it's a proper or correct choice, but I can see the logic behind it.