Freitag, September 04, 2009

Health Care Future?

This is at least honest.

...not for profit, based on group practice, led by doctors who are salaried rather than "fee for service" and subject to rigorous annual professional review.

That is how one clinic in Cleveland functions: it is, however, not the way the US health care system functions today.

What does this imply?

First and foremost: doctors become employees, service providers, and not the independent service providers that they are today.

Second: not for profit means that the complete removal of the profit motive for providing services

Third: group practice means concentrating health services geographically

Fourth: annual professional review.

All fine and good: the question then becomes:

a) what salaries?
b) what does "not for profit" mean in a competitive environment that requires significant capital outlays for equipment?
c) how are services provided for those not in large cities?
d) who makes the reviews?

The first, the question of salaries, becomes critical when it comes to making the job of "doctor" attractive. Because it does reduce becoming a doctor to just that: a salaried job. Currently, relatively few doctors find this attractive.

The second is partially tied in with the first: patients will be either directly or indirectly charged an office fee that covers basic costs. One other factor that needs to be addressed is how to reward specialization and innovation: without rewards, both will not occur the way that they do now.

The third becomes a question for spatial econometricians, determining where clinics need to be placed, and is an implicit rationing move as well (not having a clinic near where you are means death if you are too far away to receive timely care!).

The last is something that the profession can work out.

In any case: why does the government need to become involved? This is a business plan, not a recipe for health care, and by all means this is probably a viable model for providing lower-cost health care than we currently get in the US.

But: why does the government need to get involved?

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