Reforming health care using the Massachusetts model won’t relieve ER overcrowding

It’s looking more and more likely that federal health reform will look very similar to what’s going on in Massachusetts.

As I’ve written in the past, expanding coverage is easy, controlling costs is not. And Massachusetts has taken the route of least political resistance and did the former.

I’ve written previously that expanding coverage without re-aligning incentives to produce more primary care doctors will simply increase waiting times and crowed ERs statewide. Which is exactly what we’re seeing.

According to a recent study, “One in five adults said they had been told in the last 12 months that a doctor or clinic was not accepting new patients or would not see patients with their type of insurance. The rejection rates for low-income adults and those with public insurance were double the rates for higher-income residents and those with private coverage.”

That should be a warning sign that any potential public health option should be physician-friendly, or else it risks nationwide rejection by the medical profession.

Furthermore, “there has been little change in the use of emergency rooms for non-emergency treatment. Among low-income residents . . . 23 percent said their last trip to an emergency room had been for a non-emergency, the same as in 2006.”

Washington, take note.

Comments

http://www.futurewaredc.com Chuck Brooks
Bureaucrats have no incentives to eliminate problems, but create them where they don’t exist and expand them where they do. It has always been this way, and, as in the past, creates new opportunities for those who know how to cut Gordian Knots.
Chuck Brooks
FutureWare SCG
Bill
So, all we have to do is break the AMA’s cartel. The AMA controls the number of doctors, not the marketplace.
http://www.familydocs.org/blogs/fp-forum Carla Kakutani MD
We hate to say we told you so, but……
Insurance does not equal access (although it’s better than nothing). Nothing changes until every stakeholder recognizes they have to control costs and allow a rebuilding of primary care in the US. That includes doctors and patients, along with everybody’s favorite villians, the insurance companies and big pharma. Let’s hope we make some significant movement forward with this opportunity, rather than just a few cosmetic changes.
Healthcare Observer
You poor Americans – totally lacking in joined up thinking and action. In countries such as the UK local health commissioners plan and contract primary, secondary and tertiary healthcare to cover the local population. Yes, incentives such as paying primary care doctors are also important (and in the UK they are well rewarded and operate their own businesses, often in groups). But there is no substitute for planning – certainly not some bogus market forces.
CHenry
Bill, the AMA does not control the number of doctors. The U.S. government has far more to do with the numbers of doctors available than any other entity. The U.S. government decides whether to budget more or less for the training of residents, through the allotments made to teaching hospitals through CMS. Not the AMA. The U.S. government decides how many visas and of what kind will be issued to foreign nationals wanting to come to the USA to train and practice. Not the AMA. Specialty societies decide what has to be included in a residency program to be considered approved by the ACGME as a qualified residency program. Not the AMA. Chance and circumstance determine whether a particular hospital can attract enough patients with the appropriate mix of medical problems to support the clinical training of residents of a given specialty. That might not be hard for internal medicine, but it might be more difficult for, say, fellowship neuropathology. But again, not the AMA.
So go ahead and put your tinfoil hat on and “break” the AMA “cartel.” The cartel you speak of counts about 30% of the U.S. doctors as members. They might have a little committee that recommends whether a new medical school should be opened (except what to they do if it is an osteopathic school–I guess they don’t count) but the barriers to numbers of doctors meeting the so-called “demand” won’t be found there. Nor is it a solution to open the doors to schools that produce “graduates” that aren’t really trained–what some wingnuts propose who think the answer is in a fleet of low-standard, privately operated University of Phoenix types of places. Diploma mills are not the answer. And citizens wanting services which they don’t want to pay for is not the kind of “need” anyone can meet, no matter where one is trained nor how low you lower the standards for entry.
http://www.myrosevillechiropractor.com Jared Thomas
Well, said! I recently wrote an article on my blog questioning if doctors will be willing to work under the universal care model. The next question is will the government give us a choice. Like you, I see access to care being a major issue made worse by universal care. If the government gives docs a choice how many will take the less restrictive route of private care? If the government doesn’t give a choice how many of us will throw up our hands and find something else to do or somewhere else to practice?
Bill
chenry,
Dismiss me all you want. Obviously you’ve never tried searching with Google for the phrase “AMA lobby”.
CHenry
Bill, the AMA lobby represents exactly whom (a lot of former members of that association asked the same question)?
30%. Hardly a majority. And their “lobby” has to compete with other interested and powerful lobbies, like the AARP, the ATLA, the AHA, the insurance lobby, drug companies, big corporations, the government itself, and all of the specialty societies that more and more have assumed the role of representing doctors of specialties that thought themselves poorly served by, you guessed it, the AMA.
I do dismiss you for the simplest and plainest reasons. You are wrong.
But your time is yours to waste. Have at it.
Bill
Is the number of members the only indicator of a group’s ability to lobby? All I’m saying is that all I hear the medical guilds saying is that we need to maintain the status quo. None of them will suggest ways to increase the number of primary care physicians. In fact they will do whatever they can to prevent it.
We can debate the AMA lobby’s influence if you want. Calling me wrong doesn’t prove much.
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Michael Kirsch, M.D.
Medical reform in Massacusettes was supposed to be a model for the country. First, it didn’t have enough primary care physicians and now it doesn’t have enough money. Did they have a Plan B? Does Obama? http://www.MDWhistleblower.blogspot.com
James P. Davison
How many primary care physicians are enough? Mass has the most doctors per capita, the most primary care physician’s per capita ran ranks 5th in the ER utilization. There is no correlation between the numbers of PCPs per capita and the ER utilization rate in the US. Graph it yourself. The numbers of physicians in America are controlled by the US Government thru the number of post graduate training slots. When they determine future workforce needs they make one very unscientific assumption. They pick a base year, currently its either 2002 or 2004 and they assume that in that base year America had all the physcians they needed. Actually its all the physcians they think we could afford, but the end result is the same. Read the Workforce studies yourself.

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