Sunday, June 7, 2009

Doctor! Doctor! Give someone else the bill

I read a somewhat interesting article in the Sun about a doctor who is attempting to establish a patient owned geriatric practice. The doctor had some interesting things to say about the state of medical care:

"Marcus Welby had thousands of patients, but 90 percent were healthy," she said, which is why the television doctor played by Robert Young could devote his time to those who most needed him, Elon said.

But things have changed drastically since Medicare was begun in the 1960s, or even since she entered primary care practice in the 1980s. Now she has more patients in their 90s than under 60, she said, and many more of them are frail with multiple medical problems. But Medicare doesn't cover the intangibles involved in spending enough time with the frail elderly to get to know them and thereby provide good medical care.

I find it hard to believe that a typical doctor's patients were any healthier in the 60's. Since this article focused on older patients, it seems likely that many sickly geriatric patients today would have already died if they had reached old age in the 60s.

However, a more interesting and relevant fact about medical care in the 60s is that back then, people paid for 62% of physicians' services out of pocket. Today that figure is about 10%.

I think that fact is the root of many of the problems in the medical biz. Everyone wants the best service, and they want someone else to foot the bill. This creates disharmony between the act of patient care and doctors' ability to earn a living.