My interest in this article is twofold. From reading sources such as Meadows and LeBow’s Health Care Meltdown, it is easy to see that the majority of developed countries do surpass the United States in quality of primary care. For example, Reid notes that Japan spends about half as much as we do on health care per capita, yet their citizens see their primary care provider on average 14 times a year, compared to our 5, making the argument that it doesn’t make sense for us to spend more than our counterparts do for a lesser quality of care (9-10). It seems to be the norm that other developed countries do focus more on primary care (and prenatal care), and less on acute/emergency care, than we do, which seems to have some correlation to the lower costs in these healthcare systems. This problem also seems to come from the high cost of medical education, where students are then “forced” into specialties where they will earn higher salaries in order to pay off their student loans. So our system denies the necessity of primary care, which means that more people need to seek acute care, and then the system becomes increasingly more expensive. Meanwhile, medical students have less incentive to go into primary care, further decreasing the number of physicians who choose to specialize in primary care, which seems to only perpetuate the cycle. Obviously, one of the solutions could be to provide financial incentives to recent medical school graduates to go into primary care, particularly in urban or rural areas, through such means as loan forgiveness. However, I think that this issue of a lack of primary care goes beyond finance. For instance, this problem seems to have a little bit of the “chicken or the egg?” syndrome. While setting lower price points for services would, logically, lower costs in the system, this could have unseen ramifications as well. I think I remember reading at some point that Japan and Singapore had set their fee schedules too low and, as a result, were running the risk of bankrupting their health care systems. My concern would be that setting lower price points, without changing anything else in the system, would cause a meta-cost shift that could do more harm. As we’ve seen with other health care issues, throwing money at the situation might solve the problem in the short term, but not necessarily in the long term. Also, I think that providing financial incentives to graduates could potentially cause different problems in patient care, especially considering patient trust and cultural awareness.
While I believe Lauren makes an excellent point about the lack of primary care and the rise of urgent/emergency care in our country, I believe the authors of this article are also comparing primary care to specialty care. The problem appears to be that specialists are reimbursed at higher rates than primary care physicians, mostly because the procedures that specialists perform are able to be billed. However, reducing reimbursement by 30% for all physicians appears to be a blanket solution for a very specific problem. As a specialist trainee, I understand that my services are more unique than a primary care physicians, however, does this also require higher payment for my services? Not necessarily, as my specialty does not rely on procedures like the author's does (he is an orthopedist who is paid per surgical procedure). This actually dissaudes specialists like myself from pursuing their field and instead drop back into primary care, which is where the need lies. It seems that the 'intellectual' medical specialties will suffer the most from this 30% reimbursement cut than any other group of physicians. While it may solve the national primary care shortage, it may not solve all of our health care services woes.
My interest in this article is twofold. From reading sources such as Meadows and LeBow’s Health Care Meltdown, it is easy to see that the majority of developed countries do surpass the United States in quality of primary care. For example, Reid notes that Japan spends about half as much as we do on health care per capita, yet their citizens see their primary care provider on average 14 times a year, compared to our 5, making the argument that it doesn’t make sense for us to spend more than our counterparts do for a lesser quality of care (9-10). It seems to be the norm that other developed countries do focus more on primary care (and prenatal care), and less on acute/emergency care, than we do, which seems to have some correlation to the lower costs in these healthcare systems. This problem also seems to come from the high cost of medical education, where students are then “forced” into specialties where they will earn higher salaries in order to pay off their student loans. So our system denies the necessity of primary care, which means that more people need to seek acute care, and then the system becomes increasingly more expensive. Meanwhile, medical students have less incentive to go into primary care, further decreasing the number of physicians who choose to specialize in primary care, which seems to only perpetuate the cycle. Obviously, one of the solutions could be to provide financial incentives to recent medical school graduates to go into primary care, particularly in urban or rural areas, through such means as loan forgiveness.
ReplyDeleteHowever, I think that this issue of a lack of primary care goes beyond finance. For instance, this problem seems to have a little bit of the “chicken or the egg?” syndrome. While setting lower price points for services would, logically, lower costs in the system, this could have unseen ramifications as well. I think I remember reading at some point that Japan and Singapore had set their fee schedules too low and, as a result, were running the risk of bankrupting their health care systems. My concern would be that setting lower price points, without changing anything else in the system, would cause a meta-cost shift that could do more harm. As we’ve seen with other health care issues, throwing money at the situation might solve the problem in the short term, but not necessarily in the long term. Also, I think that providing financial incentives to graduates could potentially cause different problems in patient care, especially considering patient trust and cultural awareness.
While I believe Lauren makes an excellent point about the lack of primary care and the rise of urgent/emergency care in our country, I believe the authors of this article are also comparing primary care to specialty care. The problem appears to be that specialists are reimbursed at higher rates than primary care physicians, mostly because the procedures that specialists perform are able to be billed. However, reducing reimbursement by 30% for all physicians appears to be a blanket solution for a very specific problem. As a specialist trainee, I understand that my services are more unique than a primary care physicians, however, does this also require higher payment for my services? Not necessarily, as my specialty does not rely on procedures like the author's does (he is an orthopedist who is paid per surgical procedure). This actually dissaudes specialists like myself from pursuing their field and instead drop back into primary care, which is where the need lies. It seems that the 'intellectual' medical specialties will suffer the most from this 30% reimbursement cut than any other group of physicians. While it may solve the national primary care shortage, it may not solve all of our health care services woes.
ReplyDelete