Thursday, April 10, 2008

Massachusetts Health Care from KevinMD

The other day I got into a throw-down with some other readers at KevinMD over the doctor shortage in Massachusetts. Kevin rightly observed that, with a government mandated insurance coverage more people would be seeking care and waiting lists and costs are balloning. The only way to offset this is to ration care (which is not in the governments interests should they choose to get re-elected) or I would argue, increase efficiency. In fairness to Kevin, no amount of efficiency change is going to solve the problem (but it wouldn’t hurt). Finally, the piece was taken up by the NY Times and the s*** really hit the fan.

I commented at the blog that the people were still waiting prior to the insurance coverage but weren’t counted because they never joined the insured queue. I got pounded.

I don’t want to take up a political cause, but it raises the fundemental question of when does waiting start? By definition we have to judge wait from the patients’ perspective. To the patient sitting in their living room with some ailment, it doesn’t matter if their waiting because the doctor is too busy or because they have to save up enough money to go. Waiting is waiting. I’ve read a million arguments for and against private health care and I still don’t know which is best – quite frankly I don’t want to join the debate because you need to really study the numbers to have an intelligent conversation.

But I will say this, whether private or socialized or partially socialized we all want people to have timely access to care. As Massachusetts (and many countries), works to solve their problems my advice to the governor would be as follows. Don’t pay primary care doctors, nurses and health care providers less or limit their billings. It won’t be worth it to them and they’ll stop providing care then you’ll have a real headache. Judge waiting from the pateints perspective but take into account those that are not accessing care due to lack of insurance as well as those with insurance. Take a hard look a patient segments – some waiting is OK as long as it doesn’t put the patient at risk. You do not have the money and health care personnel to provide care to 600,000 more people so there are only two options: ration care or provide real asisstance to the doctors, nurses and health care providers to increase efficiency with training, benchmarks and infra-structure. Efficiency measures and patient satisfaction have to become part of the scorecard you’re using to determine where to put the money you have but the scorecard needs to be built on the waiting that patients face.

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