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July 30, 2007

Comments

This is brilliant suggestion. Docs should be paid just like lawyer. Even a phone call will be worth some money. Luv it!

If patients paid their own doctor bills, your plan might work.

But insurance companies don't want to pay by the hour, for a number of cogent reasons: they would not be able to force down prices as they do for piecework; they don't want to deal with different hourly rates; they would have trouble measuring performance; and they suspect they would get more fraudulent bills. (If they capped hourly rates and fixed maximum times by diagnosis, we'd just be back to piecework.)

The only people insurance companies pay by the hour are lawyers, and that's because their market positions are reversed.

Here is an (I think) interesting look at the health care industry. It's an alternative viewpoint that I have never seen portrayed in the popular media.

http://www.mises.org/fullstory.aspx?control=1588

The reason of course is that the current medical legal/insurance system (in many ways one and the same) make this very difficult.

Don't you just love the schmealth care system in America? So much for lower prices, high quality and efficiency that captialism promised us!

So much for lower prices, high quality and efficiency that captialism promised us!

Read the link I posted above. You can say a lot of things about the American health care system. In some respects, there are still some vestiges of a free-market, but overall not really.

If the free-market fails, point it out and lets discuss, but I really hate when people point to overly-regulated industries (e.g. "privitization" [haha] of energy markets that fail miserably) as failures of free markets. Health care (including insurance, pharmaceuticals, etc) is one of the most heavily regulated markets in this country. I hardly think capitalism gets the blame for this one.

The NYT article is simply ridiculous. The author wants to bring down the US health care cost by reducing the paycheck of the physicians. Let's do the math, shall we?

There are 700,000 physicians in the US. They make $ 200,000-300,000 on average. If we strip them off $ 100,000 each then we saved $ 70 Billion. A lot of money, right? Yes, but the US spends $ 2 Trillion a year on health care.

By cutting a half or a third of the physician salary we saved exactly 3.5 % of the health care cost! If physicians would work for $ 0-100,000 then we would save 7 % of the US health care costs! Not nothing but not exactly earth shattering, either. Of course, we would end up with some physicians who are homeless (the $ 0 category) and they would overtax the homeless shelters and aid agencies and we would have a lot more panhandlers.

The supply of new physicians is tightly controlled. There are ~16000 seats for incoming allopathic medical students and that number hasn't changed in the last 50 years. Every year, thousands of highly-qualified applicants are turned down (I was one of them). While there are Caribbean school alternatives, as well as thousands of foreign medical graduates trying to get in the US, post-graduate physician training is still tightly regulated by the residency matching system.

Physician shortages are further being exacerbated by increases in women entering medicine (who now outnumber men in medical schools), who are less likely to work full-time due to lifestyle and family choices. Furthermore, many of the best doctors-in-training seek and end up in a high-paying but not publicly-useful nor very-demanding specialties such dermatology or anesthesiology.

Allopathic medical training is overkill for the majority of minor medical and preventative needs. There ought to be a new class of licensing and oversight for primary-care that doesn't take 8 years of higher education and doesn't involve the AAMC.

p.s. why are physician rates never discussed, advertised, or haggled over?

"Furthermore, many of the best doctors-in-training seek and end up in a high-paying but not publicly-useful nor very-demanding specialties such dermatology or anesthesiology."

Not publicly useful. OK, next time when you have your surgery, do it without an anesthesiologist.

"p.s. why are physician rates never discussed, advertised, or haggled over?"

They are by the insurance companies and Medicare.

BTW, Medicare pays about 2 or 3 dollars for some specialists to visit their patient when they are hospitalized. It does not even cover the price of gas! The reason why physicians still do it because their patients expect it and they do not want to lose their patients. The physicians I know stopped coding for these visits because it does not worth the hassle. They do it out of pocket.

I love how lawyers always want to tell physicians how to run thier operations.

How can physicians be paid by the hour if the physicia/optometrist/dentist works for himself in a stripmall/office park somewhere? If they do not work, they do not earn. To be paid by the hour, you have to work for someone else.

Physicians are paid the same for a procedure whether they passed their boards last week or have 30 years experience and are chief of their service at the Mayo Clinic. Image if all laywers were paid the same for talking to you on the phone? It is one of the issues with single payer: skill and experience are not rewarded.

"Not publicly useful. OK, next time when you have your surgery, do it without an anesthesiologist."

It is a very undemanding subspecialty these days. It should now be transferred to a 2 year associates degree. Seriously! It's basically all controlled by software and has built in safety features. Read the chapter on it in Atul Gawande's "Complications". In many countries Anaesthetic Technicians do essentially the same job as MD's here. (But I don't have any data on mortality rates)

gymquiz,

Much of the actual work is done by nurse anesthetist who have a masters degree. However, I do not believe that they are paid by the hour any more than the anesthesiologists. A nurse anesthetist can easily make six figures with a MS from a directional state university.

If you really want to save money on medical bills, go here:

http://www.hesperian.org/publications_download.php#wtnd

Or here:
http://www.fas.org/irp/doddir/milmed/index.html

The publications are free! Actually, the stuff is pretty good to know and may save a life or two, maybe your own.

Nurse anesthetist - now that is probably one of the best kept secrets of the nursing/healthcare industry.

Of course, this would still encourage them to perform unnecessary but time consuming medical tests and procedures, but it still makes more sense than paying based on how many checkboxes they can check off on an insurance form.

If doctors received slightly higher pay for the first thirty minute or one hour period than in the rest an appointment, this might reduce the tendency to perform unnecessary tests.

On the other hand, if the pay were too substantial, this might encourage fast-food-style health care.

A phone call to the doc sounds like a good idea to someone who isn't a physician.
It is just plain unsafe medicine.
When a patient calls a physician with a complaint, they sometimes use inappropriate medical terminology to describe their symptoms. If I relied completely on their description, I would be led astray at least 70% of the time on the diagnosis and therefore the treatment. A patient needs to be seen in order to be treated properly.

A phone call to the doc sounds like a good idea to someone who isn't a physician.
It is just plain unsafe medicine.
When a patient calls a physician with a complaint, they sometimes use inappropriate medical terminology to describe their symptoms. If I relied completely on their description, I would be led astray at least 70% of the time on the diagnosis and therefore the treatment. A patient needs to be seen in order to be treated properly.

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