Healthcare Professionals for Healthcare Reform

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I recently had a conversation with Dr. JoAnn Manson about our healthcare plan and she had many insightful comments. One of the concerns that she brought up is how this plan might overload the primary care physician’s practice. Now, the increase in volume of patients is something that we had anticipated with our plan and had thought that it would be an advantage for physicians.
As I looked over some of our prior discussions I came across the NY Times article back in April about the Massachusetts experience and then came across a blog entry from Alan Katz from that time. These were his thoughts:

What was apparently overlooked was how the influx of newly insureds into the system is straining the pressure on family doctors and other primary care physicians. As a result there’s waiting lists for some non-emergency treatment that stretches for months in some communities. The Times article recounts one physician in Amherst that is now scheduling physicals for early May — of 2009.
The problem is a serious one. By coming into the system, through subsidized coverage or not, residents of Massachusetts anticipated having access to basic health care services. Yet there’s just not enough primary care physicians to go around.
The United States will need 40 percent more primary care doctors by 2020, according to the American College of Physicians, to accommodate the aging population. It’s hard to see where they’re going to come from. The reasons are many. As the Times story reports, factors include reimbursement rates by Medicaid, and the attraction of a specialist’s practice among them. What’s ironic is that Massachusetts ranks significantly above the average in the per capita number of all doctors and primary care physicians.
Which does one little good if you need a doctor and can’t get one to see you. And none of this means attempts to achieve universal coverage should stop. It just underscores how tough a challenge it will be to make any reform package work.

Be that as it may, it seems to me that this may not be as big a problem as either the NY Times or David Katz think. Part of the reason that patients in the Massachusetts plan cannot get access to primary care physicians is that their newly acquired insurance is Medicaid which pays providers less than 20% of Medicare and even less than private insurance. This effectively bars a significant part of the population from access to private physicians. In other words, there is not enough incentive for the care providers in the Massachusetts plan to really allow for more access. This should not be the case in the HPfHR system (or a single payer system either) since everyone will have the same insurance (at least for Tier 1 services).
That’s not to say that I don’t believe that when the HPfHR system is first established there won’t be an initial influx of newly insured patients flooding the available primary care offices. However, I do think that in the free market (and with some help from enhanced reimbursement from the “Board” and drastic reductions of the overhead associated with dealing with private insurance) primary care will become significantly more attractive. In addition, there is now a significant growth in the ranks of physician assistants and nurse practitioners that is already helping primary care services.
Please let me know your thoughts…


August 5, 2008 - Posted by | Uncategorized

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