Dr. Crippen asks whether if only the rich gets to see physicians.
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In managed care, you see the same sort of thing these days.
For instance, a patient makes an appointment for his annual eye exam.
His appointment is booked with an optometrist. Upon arrival at the Eye Clinic, the patient is greeted (!) by the optometric tech, wearing a white jacket, but minus any name tag.
The tech conducts most of the eye exam, excluding the retinal exam, taking about 20 min total.
Then the optometrist comes in, looks at your retina, re-checks the IOP (if you’re lucky )and tells you’re disease free. Total time with optometrist is no more than 5 min.
Insurance is billed the standard fee for a “visit” to the optometrist.
If you have an allergies to meds, write them down on a card, before your “visit” as most techs know little or no pharmacology.
Likewise, prior to your “vist”, write down on a card, all of your meds and their dosages.
Be sure, the tech reads the print on these cards and then records the data on your chart.
One error by one tech is easily tranferred throughout the system, causing problems for patient down the road.
If you feel you have an eye problem, be sure to see an opthalmologist (MD ) not an optometrist ( OD ).
“Then the optometrist comes in, looks at your retina, re-checks the IOP (if you’re lucky )and tells you’re disease free.”
So true, if you are lucky. If you are not so lucky, the optometrist tells you that “you have a cataract” and need to be referred for surgery. You are then referred to the surgeon, who all too often pays a kickback “comanagement fee” to the optometrist in exchange for such referrals. And yes, Medicare permits this.
Sometimes the patient turns out to have a brain and seeks an independent second opinion from an ophthalmologist. It is always enlightening to see an asymptomatic patient with minimal cataract who does not need surgery. How often do you think the surgeon with the kickback financial arrangement has the courage to tell the referring optometrist that he/she was wrong and the patient does not need surgery?
Why Medicare permits “comanagement” in this day and age, especially in large urban areas with surgeons readily available and accessible to their patients is beyond me. Patients should be referred to the surgeon the optometrist thinks is the best and most convenient for the patient, not one from which he derives a kickback. I would encourage any patient referred by an optometrist to a surgeon to inquire about financial relationships and hope you get a straight answer. ALWAYS be suspicious if you are referred to a doctor or surgery center way across town. My best advice is to seek a second opinion from an ophthalmologist of your choice.
Two-tiered or multitiered health care is inevitable and is actually a good thing. The only way to eliminate it would be to impose a degree of totalitarianism that even the soviet union was unable to achieve. The powerful always always always provide better for themselves.
So it’s existence merely means that we have not yet achieved the ultimate state of no freedom.
The poor get a major benefit from two-tiered medical care in that the upper tiers define an objective for and illustrate the defficiencies of the lowest tier. They are never all corrected of course but the contrast and shame exert a salutary pressure effect towards improvement, or brakes to the decline.
Also the poor get the leftovers. Sounds ugly but a man who can’t afford to pay for his own food will generally eat better off the leftovers of the rich than he will the leftovers of his peers. Whose dumpster would you rather be diving? The Hiltons’ or another bums? The well to do giving themselves better care create a need for and incentives for more and better trained specialists and construction of extra facility capacity which then sometimes is shared with the other tiers.
Of course none of that excuses fraud in which a patient pays for one thing (an optometrist’s exam) and gets another (a tech’s exam with an optometrist’s sign off).
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