Most health care reform plans don’t address the physician shortage, leading them to be useless:
Sampson was enrolled in a plan run by a subsidiary of Boston Medical Center called BMC Health Net. But before her benefits would take effect, she had to find a primary care doctor. That’s when her frustration with the new system reached a boiling point.Sampson started calling primary care doctors within a half-hour drive of her home in Kingston. The response from nearby doctors:’”˜We’re not taking (that insurance plan), we’re not taking new patients.”
Sampson estimated she called about 50 doctors. In some cases, administrators at doctors offices said they didn’t know why they were on lists as accepting the insurance when they don’t. In others, they just weren’t accepting new patients.
Related posts:
- What if there was universal health care, but not enough PCPs to see everyone?
- Improve primary care access before guaranteeing universal health coverage, my address at the National Press Club
- Universal health care and the physician shortage
- Health insurance doesn’t automatically lead to health care
- MedGadget takes on universal health care
- My take: Dr. Nurses, supporting universal care
- 10 primary care posts you may have missed
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{ 8 comments }
Crappy plans have been known to put doctors’ names in their physician directories who do not accept that particular plan. They can always tell their subscribers that it was an “error” or that the physician withdrew when in fact he was never participating in the first place. They figure there is little chance they will be confronted with this kind of unethical and fraudulent behavior.
this is EXACTLY what is happening all over metro NY with the multitude of medicaid managed care plans.
Anyone with their eyes open who lives in one of the boroughs (especially the bronx, brooklyn and washington heights in manhattan) sees the flashy RVs with salespeople pushing medicaid recipients to sign up for HealthFirst (I call it “health-worst”), Fidelis, Metroplus, Affinity, HealthPlus, etc.
They sign up unwitting medicaid patients to these plans, get a hefty commission, then their plan takes in about $5000 per yr per pt from the state.
Then they assign patients to hospital-based clinics where they’ll wait MONTHS for an appointment to see an intern only months out of medical school.
Or if they’re lucky they’ll see a small office-based attending MD, until that doctor realizes that he (was me) gets sometimes as little as $15 per month to oversee that patient’s care. That’s about $180/yr. Where does the other $4820 go???
Just look at the flashy RVs, salesmen, and CEOs. In the end, it’s the patients who get screwed.
Make that three. Agree completely. These plans put the docs name on as participating in the plan, when they do not. Either never have, or dropped the plan years ago, but for years your name remains on their list as “participating”. Bills are processed as “in-network” when you are “out-of-network”.
You call them on it, they apologize and claim “computer error”. Then they do it again.
And again, and again, and again……been there done that.
Everyone wants the docs to use EMR’s, but from what I see of insurance claims processing, those computers sure cause a lot of “errors”.
The other thing that comes to mind. If the doc’s practice is full, that’s one thing. But if the doc is taking new patients but is not participating in that insurance, that’s another. Often that means the patient has to pay ten, twenty bucks more for the office visit.
Some of the patients described in the article may well have gone without care to save twenty bucks, or spent twenty bucks worth of gas to drive to the doc who takes the insurance…..to save twenty bucks.
Yes, these medicaid plans suck. They have no specialists enrolled. Very few PCP’s are enrolled. Their plan if you are sick is to “go to the emergency room” so they can deal with and then try to get a 20$payment from the plan after they dished out 5 grand of care.
I don’t think universal health care would be benefical for Americans. With private insurance American have a hard enough time tring to get in to see a doctor.
-Tannie Ca.
Universal Health is a great idea. More Doctor’s should make themselves accessible to as many health care plans as possible. This would surely take care of the complaints regarding compensation, while addressing the issues of affordability and accessibility.
I contend that among the reasons there is a shortage of PCP are the threat of malpractice lawsuits (there are three ads by malpractice lawyers on the previous page) and easy money in the “health care” insurance industry (there was an ad for MBA in Health Care on previous page). If taxpayers were going to fund anything relative to health care, we should subsidize the cost of medical school. Also, we must insist on major tort reform. Some, if not most, doctors acknowledge that they engage in expensive, defensive medicine. Mega jury awards in malpractice cases for “pain and suffering” must end and the AMA and its review boards need to do their parts to pull the licenses of incompetent practitioners. There should be no free-rides for anyone.
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