There’s little doubt that strengthening our primary care system is a priority in health reform.
But how do we pay for it?
The WSJ’s Ben Brewer (via the WSJ Health Blog, which has an excellent discussion in the comments) comes up with a few ideas, and not all of them are going to go over smoothly.
One involves moving money earmarked for the Medicare Advantage program to fund primary care. Insurers will balk at that suggestion.
Another idea, often discussed here, is to “lower the Medicare pay scale for specialty care, lab tests and procedures,” and to “expand the use of non-physician personnel to deliver repetitive procedural care like colonoscopies.” That will meet significant specialist resistance.
Dr. Brewer rightly points out that importing foreign doctors is not a viable solution, as these physicians will not be immune to the disincentives that plague the generalist system, and soon enough, they will be looking for a way out as well.
Neither is pouring money into a national health information project, which does nothing for the delivery of care or the administrative burdens that currently accompany it.
The WSJ Health Blog conducted a poll on the topic, asking its readers how should primary care be funded. The results did not show one consensus solution, which the ACP’s Bob Doherty interprets as trouble, “and with 22% saying ‘primary care doesn’t need the money,’ the consensus for primary care may be weaker than it appears.”
Related posts:
- Universal coverage without primary care
- Reducing the paperwork burden on primary care
- Primary care doctors struggle to survive, even in Beverly Hills
- Patients feeling the primary care pinch
- Primary care
- Will a 10 percent bonus for primary care be enough?
- Primary care and the elderly
{ 7 comments }
In most cases, “we” shouldn’t pay for it at all.
Primary care, when stripped of the extra overhead and inflated prices of third party payment, is not expensive enough for most patients to need a prepayment system. Many of our patients spend more on their cable and cellphone bills than they would keeping their blood pressure under control.
For those with many complicated illnesses and the destitute, of course we’d need a safety net of some type. Everyone should have a catastrophic policy of some type. But that’s no reason to keep primary care trapped in layers of bureaucracy.
This is more likely to save primary care than any complicated medical home schemes. It may keep enough physicians in primary care to offer patients an alternative to just midlevels.
I’ve been following that WSJ thread for a couple of days. I just have to wonder, didn’t anyone listen to President Obama’s inauguration speech last week? Everyone is going to have to step to the plate to make change happen. In primary care, that means in order to get more money we need to be doing real care coordination and population management and really use our skills to improve quality and save the system money. Some primary care docs have adapted to the current financial environment by abandoning those skills (you can’t really blame them, the system encourages that) and that gives subspecialists ammunition to say we don’t deserve anything more. On the other side of the equation, the profession as a whole has got to admit that reimbursement in certain parts of the system is out of hand and creating the warped playing field we have now, with real public health consequences.
If nobody is willing to budge, our infighting will keep us from showing real leadership. And without leadership this opportunity for healthcare reform may be lost, because there are lots of powerful interests perfectly happy to keep things as they are.
The problem with comparing healthcare with a cell phone or cable is if the bill is not paid, the patient then loses their cell phone, or their cable.
A better analogy is car care. Most people can afford 3,000 mile oil and filter changes but still do not choose to do it. As a result, they run the risk of a major breakdown which will cost them many times more. Well, that’s their problem right?
But here’s the catch: if a patient chooses to not get check ups, such as someone with hypertension or diabetes, even if they are affordable, and then gets a major complication such as an MI, hyperosmolar coma, a stroke or renal failure, what should we do? Then we,as a society, wind up footing the bill for the care, either through higher insurance rates, medicare/medicaid, or uncompensated care.
I know someone will say, “well, it’s the patient’s responsibility” but that is a moot point. The patient is then sick and needs more expensive care, and someone has to pay for it.
A family practitioner
Kevin, there are no ideas for fixing primary care that will not meet any opposition from some interest group. Nevertheless, if this nation is serious about fixing the system, some groups will just have the suffer their loses. I just hope it’s to the benefit of the educated and self-helping patient.
“That will meet significant specialist resistance.” Who cares!?
…besides the specialists themselves, obviously.
As a Canadian medical student I’m amazed at the little gold mines which exist in medicine. Things like colonoscopies, cataract surgeries, and much of radiology pay-out ridiculous amounts of money given the time and skill those things take.
As more and more of medicine starts being done entirely by computers (run of the mill radiology, reading ECGs) or at least heavily assisted by computers (internal medicine), I hope whiny, obsolete specialists aren’t given the chance to stand in the way of progress.
Family Practitioner:
If they do actually live longer as a result of better primary care, then they cost “somebody” more in the long run anyway. The old dog about saving money just doesn’t hunt anymore.
Medical care is a private, not a public good and private individuals should pay for their own.
Anonymous 6:46:
Are you saying that chronic conditions such as hypertension and diabetes are not worth treating?
And who pays for medical care when people cannot afford it?
A amily practitioner
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