HEALTH CARE FACTORS #1

The ACA aka “Obamacare” is only one of the factors that are causing the loss of excellency in individual health care. In fact Obamacare is only the continuation of a radical socialization of 

American health care.

Believe it or not that despite the Democrats always beating their drums of being for the common man it was a Republican President, Richard Nixon, who oversaw the passing of the Health Maintenance Organization (HMO) act of 1973.

HMOs had been around for years and were not very popular; there being only 40 in the entire country at that time. The act however provided for subsidies to cover the cost for the carriers, and the many entrepreneurs who jumped in feet first.

This was the beginning of the death throes of the patient/physician intimate relationship. No longer did many patients have their choice of doctors but had to choose from a panel provided by the plan’s operators. Also because of increased paper work and the need for authorizations the doctor’s office became a business office with increase in personnel.

There has been a significant disparage between incomes of primary care physicians which includes generalists, internists and pediatricians from that of specialists. The net results is a decrease in doctors entering those basic areas which has in turn increased the wit for appointments and the delegating services to PAs and Nurse Practioners.

A survey taken by Merritt Hawkins before the latest expansion of covered patients showed: Boston is experiencing the longest average doctor appointment wait times of the 15 metro markets examined in the survey: 72 days to see a dermatologist, 66 days to see a family physician, 46 days to see an ob/gyn, 27 days to see a cardiologist, and 16 days to see an orthopedic surgeon.  On average, it takes over 45 days to schedule a doctor appointment in the Boston area, the survey indicates.  In each of the three years Merritt Hawkins has released the survey (2004, 2009, and 2014) Boston has averaged the longest physician appointment wait times among the 15 cities.

Other average physician appointment wait times tracked by the survey include 28 days to see a cardiologist in Denver, 49 days to see a dermatologist in Philadelphia, 35 days to see an ob/gyn in Portland, 18 days to see an orthopedic surgeon in San Diego, and 26 days to see a family physician in New York.  Physician appointment wait times tracked in the survey varied from as little as one day to over eight months, with an overall average in all metro areas and all specialties of about 19 days.

"The demand for doctors is simply outstripping the supply." 

The survey also tracks how many physician practices accept Medicaid as a form of payment in the 15 metro markets.  Boston has the highest rate of Medicaid acceptance tracked in the survey at 73%, while Dallas has the lowest at 23%.   The overall average rate of Medicaid acceptance for all five specialties in all 15 markets is 45.7%, the survey indicates. 

Many physicians are not accepting Medicaid because it often pays less than what it costs physicians to provide care, Medicaid patients, and patients with private insurance, often seek "convenient care" in hospital emergency departments when they cannot access office-based physicians in a timely manner.  The problem of physician access could become more pronounced “

The Medicaid acceptance rate seems to be conversely equivalent to the waiting times for appointments.

As I have noted the increase in patient loads and the decrease in primary care physicians has tended to the formation of groups and adding the services of auxiliary professionals. The demands for 

reports and electronic record keeping, billing, reports, and esoteric standards has required  large support staffs; all of which increases operational costs.

That increase can only be met by increasing patient volume. The net results are more and shorter visits per patient encounter visits. Since time is finite there obviously will be longer periods between available visit slots; thus the long waits for appointment. This is why people tend to use the walk-in facilities and ERs.   

We will continue with comments on how the all mighty dollar is continuing to change the system.

4 more days to #94 and DAWG