Future of Medicine- an open-minded forum

[rhillstr]

Hey Everyone,
I'm tired of the repetitive squabble of DO, MD, MCAT, and GPA. These are good topics but I would like to try something else. HMO's, the future of healthcare funding, socialized healthcare, and anything related. What you like, what should change, and where do you see it going.
Hear from you all soon,
Rob

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[Deb]

What a refreshing change! Here's my two cents. While I'm not in favor of a
socialized system (except for low income children...there are MANY who still
don't qualify for medicaid), I do have a problem with "for profit" institutions
involved in health care (HMOs). Instead of a system that funnels profits to
shareholders, I would like to see "not for profit" insurers that use excess
funds for research and indigent care (which would lead to less cost shifting,
which in turn would lead to lowered premiums...at least in theory). I also
feel it's time insurance companies started sharing the costs of medical education
(which is something that actually IS being discussed). The way things are now,
insurers reap all the rewards but share little of the risk or burden to society.

[This message has been edited by Deb (edited April 14, 1999).]

 

[mevannorden]

Although I am not in favor of a socialized healthcare system, the sad truth is that a large part of it is socialized. A large number of potential patients are Medicare/Medicaid, which, of course, is govt. money. There are definitely shortcomings in the current system, and, like Deb, I have a problem with for=profit providers/payors who put profits ahead patient care. I for one have thought about this topic A LOT and my feeble mind can think of no solutions. The truth is, there are no easy solutions. Whatever the soln. is, it will take sacrafice by somebody, if not everybody. If anyone has any good ideas I also would like to hear them. Think hard! It's our future at stake!

 

[edgar]

The whole issue about our healthcare situation is that Americans are schizophrenic about what they want from medical care. Right now we believe that everybody should get medical care and it is a right, and if an indigent 2-year old baby girl has a horrible disease, it is our duty as taxpayers to pay for her treatment. Then we have managed care which is out of reach of the indigent, which the lucky ones in our society get coverage from but don't get the "spend at all costs" treatment like the 2-year old would. That's why this issue is so complex and difficult to solve easily. Another problem is also the greediness of HMOs/Managed Care Organizations. They snuck in through the backdoor, and eliminated the fee-for-service system because they labeled doctors/hospitals as self-serving and profit hungry. What do they do? They monopolize America's health system and are increasing their premiums/bills onto the public. I say they got in through the backdoor because they promised that they will reduce escalating health care costs, but once they got a taste of the incredible profits involved, they became more greedy than any doctor ever could have been. It is my fear that all HMOs are going to be taken over by the government anyway, and we will be stuck with our medical school debts just as we see our earnings drop through the floor.

EDGAR

 

[OldManDave]

Excellent topic choice!!

You are correct, HMOs/managed care...has not controlled the 'spiraling costs of healthcare,' as they originally promised. They have succeeded in tarnishing the image of physicians, and the healthcare professionals in general, as a component of their efforts to pursuade the public to buy into their idea. Managed care's biggest achievement lies in that they have succeeded in diverting a significant portion of the revenues generated by medical professionals [the people who perform the procedures and provide the services] to thier own pockets AND simultaneously ensure that they don't have to share in the accountibility. In essence, they have created a system where they have enormous influence over the cash-flow, and hence 'practice medicine' via control of the all-mighty $, while shouldering ZERO liability.

Furthermore, it is a common mis-conception of how profit-driven hospitals are the only ones who cut corners to preserve the bottom line. I have worked in both for-profit and non-profit facilities...they BOTH are equally driven to cut the same corners. The reasons they give and the titles of the programs differ; but it always boils down to forcing medical professionals into performing progressively more patient care with fewer and fewer resources and paying them comparitively less vs other professions.

It is a sad and scary state of affairs. But, ask anyone in the general populice and they will always tell you, "Yes, I want cost control in medicine. I am tired of paying all my hard-earned money to those medical people." However, confront that same person in the ER when it's his wife, child or parent...they are vehemently opposed to any sort of cost considerations factoring into the care of their loved one. They want everything done at all costs...as would I, were I in that position. But, you can't have a system where cost control enters the patient care decisions only on the other person...

The solution...I like what Deb has to say. Who knows, some permutation of your idea could be the next generation of healthcare delivery. I'd be willing to help develop it.

------------------
'Old Man Dave'
KCOM, Class of '03


[This message has been edited by OldManDave (edited April 15, 1999).]

 

[rhillstr]

It seems to be very prominent amongst the responses that the idea of socialized healthcare is not popular. I haven't heard your reasons though. What's wrong with socialized care? Is it the pitfalls in Medicare and Medicaid? I agree about non-profit insurers, but if they are non-profit you still have the populice covering the expense of the sick, isn't that almost socialized healthcare? Many have complained about the governments uneffectiveness and wastefulness and use those as reasons against this type of system. I agree that the attempts to point the finger at the physician and stip them of time and salary is awful. Something has to be done to stop this. Some HMO's are supposedly going bankrupt. How the heck to you do that? Most of the money in the healthcare system is pooled there. Indigent care is a major issue and I agree with Dave. Deb is on to something. Keep the feedback flowin'
Rob

 

[Mattie]

I currently work for a Health Care Financing Administration (HCFA) controlled peer review organization (PRO), so allow me to comment some on the state of Medicare. My organization is under contract to "ensure quality health care for Medicare beneficiaries." How do we do this? There is SOME case review. But the focus of our work since 1993 is doing positive, quality improvement projects (the Health Care Quality Improvement Program, HCQIP). HCFA has decided what the clinical topic areas will be for these projects for the next three years - pneumonia, mammography screening, diabetes, stroke, AMI, and congestive heart failure. It is our job to improve the quality of care by using some kind of educational intervention with the providers of care (namely physicians) and taking measurements both before and after the intervention to judge the effectiveness of the project. Does it work? Maybe, in some situations but I am not convinced. Is it full of politics and bureaucracy and not really focused on the patient? In my opinion, yes. Most physicians hear the words "peer review" and take cover and don't even know that there has been this "new" move to positive, educational projects. There are many, many issues surrounding these projects with, perhaps, the biggest obstacle being that the employees who try to reach out to these providers and educate them are not always clinicians themselves and have no concept of the daily happenings in a clinical setting. Consequently, the providers are less than receptive to their efforts.

I agree that something needs to be done about the state of our country's healthcare system but, unfortunately, I don't have a solution. If you haven't read the medscape article posted elsewhere about market driven medicine it brings up many good points.

This is sort of an unrelated point, but one that demonstrates the inadequacies of HCFA: HCFA recently released a request for proposal (rfp) for the next series of three year contracts for peer review organizations. All offerors were given the opportunity to ask questions about the rfp and HCFA responded with answers to these questions. Someone asked the following question, I quote, "If the HCQIP Director is an MD, the salary cap is $163,000. But if the HCQIP Director is not an MD, the cap is $143,000. Do you mean the non-MD to be defined as other than a medical doctor, i.e. a doctor of osteopathy? Are MD and DO interchangeable relating to the salary cap?"

HCFA's answer, I quote, "No. In order for the HCQIP Director to be at the $163,000 salary cap, the person must be a BOARD CERTIFIED MD."

As you can see, there are some problems. I have been in contact with the AOA's deparment of governmental affairs about this and they are looking into it. I'll post what I hear.

Others thoughts?
Laura
UOMHS '03

 

[DOPhD student]

Probably the same ignorance as with he INS.

 

[rhillstr]

What kinds of wisdom can you guys share about the current options. I regret to say that I am not totally hip. I am prepping for interviews and such. Capitation, PPO, etc. I get the idea of HMO's but whatever elso you can input on would be wonderful.