pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Cost Effective Medicine – why can’t we seem to find it?

There is a lot more discussed these days in medical meetings than medicine!

The new topics include computers, credentialing, new governmental rules, insurance company policies to control medical costs, and political maneuverings. Now these topics are neither particularly new nor worrisome, but the list just doesn’t stop there.
Medical costs outta’ site, big business

There are things being talked about which affect the very fiber of the physician/patient relationship and the delivery of health care, as we know it.

Things like the “doctor glut”, advertising by physicians and hospitals, competition, “capturing the market”, building a patient base, “cost shifting”, “rationing of medical care”, medical costs and numerous other related topics.

Medical Costs

You may neither be aware of nor understand these topics; nor realize that your state and city has seen a significant change in the delivery of health care in the last year or so.

Most physicians in this area, I believe, are somewhat like me and occasionally become tired of all this “business/political stuff” and long to spend more time in just delivering the best possible medical care, in the most cost—effective manner, for the most benefit to the patient (not insurance companies, governmental agencies, or entrepreneur businessmen).

In fact, some meetings in which these topics are discussed can be downright depressing.  I notice, though that the medical profession does not have a corner on the market for problems or change.

While waiting to deliver a talk in an Elementary School faculty meeting, I listened as meetings were announced to discuss all of the various proposals and regulations to upgrade the quality of education in their schools.

Educators I guess are seeing similar changes in their profession, and I suspect that executives of the Bell telephone system, and others, sat through many such meetings going through their split up.

There have been panels convened, workshops attended, and reports written about who or what is to “blame” for increasing medical costs.

For example, there is:

  • increased “meddling” by governmental bureaucrats; 
  • production of more doctors than are needed; 
  • misdistribution of physicians; 
  • the need for increasing specialization; 
  • exploding technology; 
  • delivery systems managed by entrepreneur businessmen (non-physician and physician); and 
  • burgeoning numbers of disrupted family situations with resultant dependency on the welfare system.

Yes, all of these are problems; but the fact remains that the United States has the highest quality medical care of anywhere in the world. Think about it.

The vast majority of the world’s inhabitants live where they have: less access to – and a more limited amount of- less up-to-date medical care and facilities.

Ask anyone who has been to Russia, China, most of Europe, and in many respects even England and Canada.

Now, I am right in the middle of it – this changing system; and I know for a fact that there are inequities and problems.

Nearly every aspect of medicine is under scrutiny, not only physician/hospital reimbursement, but also your rights as patients.

There are already types of insurances requiring “preauthorization” from headquarters for certain medical procedures.

Physicians are more frequently found in positions that test their professional integrity when making decisions between patient advocacy and pressures from insurance companies and hospitals.

There are articles every month in medical literature about what insurance companies and the government are considering doing to prevent patients from seeing their doctor’s as frequently and limiting/excluding hospitalizations.

Changes are coming. My colleagues and I are helping to make some of them and desperately trying to prevent others.

In all the change, however, I believe that we must begin with the basic evaluation of our system “judged by its fruits,”… a great one.

And in advocating changes we should keep as our underlying premise one of our physician’s mottoes Primum Non Nocere — ”First, do no harm.”

On occasion in this column (amidst medical articles) I will give you an inside” view of the medical care system and, in a positive way, describe how you can use it to your advantage.

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