Should doctors be forced to treat patients promptly?
New regulations to reduce wait times for medical care in California are due to take effect next year. Under the proposal, primary care doctors employed by HMOs are required to see patients within 10 days of the appointment request, and specialists must see patients within 15 days. Telephone calls must be returned within 30 minutes and patients needing urgent care have to be seen within 48 hours…In San Diego, patients wait an average of more than 3 weeks for a routine physical. In Los Angeles, the average approaches 2 monthsHow long does it take to get an appointment at the Apple Genius Bar?
When you pay an insurance company $11,000 per year to micro-manage your sickcare usage, you lose the status of “paying customer” in the eyes of physicians and hospitals. Customers are “a person or organization that buys goods or services from a store or business.”
The current customer of the sickness industry (hospitals/doctors) is the health insurance industry.
If you take back the transaction from the insurance companies, you take back “customer” status. And once you become the paying customer, when your body breaks, you’ll start being treated like Apple treats customers with broken computers.
Jay is right on with this post in identifying the deeper reason why doctors are being forced to see patients sooner. When there is a need in an economy that is not being met (timely visits) ask yourself first why the system currently fails to meet those needs without force. Usually there is some entrenched mechanism keeping the need from being met through free exchange. Is medicine so unique that healthcare workers can’t imagine that it might be a good idea to get patients into the office quickly for referrals or return phone calls promptly? Of course not. But it does work under an arcane, labyrinthine payment (read incentive) structure which serves neither patients nor physicians well.
A few examples:
If you see a new DVD or book that you like and you want it NOW from Amazon, what do you do? You can pay $0 for regular 3-5 day shipping or you pay extra to get it overnight shipped.
If your kitchen plumbing gets clogged on a weekend and you want to have a plumber come out and fix it, what do you do? You pay a little extra and a plumber comes to the house immediately and presto- it’s done.
In each case you the customer paid a premium for timeliness. You recognized implicitly that instant service comes at a price. Calling on a business to meet your need immediately meant that they had to summon scarce resources (manpower, transportation, skill) toward your need and hence away from other scheduled needs.
Does this (can this) happen in medicine? In large part - No. When was the last time you got in to see the doctor on your schedule unless you had an emergency or knew somebody? If doctors’ offices worked like the above mentioned businesses, all you would have to do to get in sooner is pay a little higher premium. But because people prefer to pay through an intermediary, this doesn’t happen, in fact it legally can’t happen in some instances. It would be illegal for you to pay a higher copay as a Medicare patient to incentivize the doc to see you sooner. Unfortunately healthcare delivery acts under the same constraints as other businesses: limited time in the day, limited resources, limited energy. But the current payment structure makes no provision for this. For elective care, intermediaries pay healthcare professionals stock payments based on entrenched diagnosis and procedure ”codes”, not timeliness.
This is the tradeoff the patient makes for not being a customer.
