Comments on: The rural medicine shortage

By: Anonymous

Anonymous — Wed, 25 Jul 2007 00:23:00 +0000

It sounds like you are saying that you can’t set your fees, at least for Medicare. I would think that is more the real problem than poverty. I live in the poorest region of the country and the rural folks here pack into casino’s at 70-100 a visit and do so several times a month on social security checks. It is just a matter of whether or not they want the service and value it.

And if they don’t value it enough to pay for it, why should I give a crap if they don’t get it?

By: Anonymous

Anonymous — Tue, 24 Jul 2007 00:16:00 +0000

They already can “charge more”, the problem is that many rural areas are low-income and generally are not populated by people who could pay well enough to attract a practitioner on those terms. Add to that the fact that any patient in the Medicare age group is by law only allowed to be charged 115% of the Medicare allowable unless they agree to privately contract for care, an arrangement that by federal law has to be documented as a contract and must have written acknowledgment by the patient that the services being contracted for will not in any way be paid for by Medicare, even if the patient is eligible. Worse, by making even one contract for one service with one patient, the doctor becomes excluded from compensation for all Medicare-covered services for a whole two years. So unless the 115% maximum can produce enough revenue to run a practice with higher charges, assuming that patients in that location can afford so see a non-assignment-accepting physician at all, the physician might not have enough business.
The local patients could very well find themselves driving past the rural doctor’s office to another doctor much farther away just to see someone who accepts Medicare assignment, or at least remains within the 115% upper charge limit to avoid the private contract trap.

Charging more doesn’t make a viable market any more than does a population unable to afford care, both are conditions of a non-market. If the operating costs can’t be exceeded sufficiently to make an acceptable income, it hardly matters whether there are too few patients who can pay more or too many patients who can’t pay enough. Neither works.

By: Anonymous

Anonymous — Mon, 23 Jul 2007 23:38:00 +0000

It’s a free country. Why don’t they just charge more? If they can’t charge more, the need in those areas must be met. If people need a good or service, the price will rise until the demand is met. Basic economics.

By: Happyman

Happyman — Mon, 23 Jul 2007 23:31:00 +0000

the answer is just so simple, only a politician couldn’t see it: pay them more.

Instead of wasting money on such middlemen like recruiters, pass the money onto physicians – i’d say it’d take at least $350,000 to lure a general internist away from a developed area to upstate NY, more for a medical or surgical subspecialist.