| How Health Insurance Has Changed the Practice of Medicine With over 25 years in the medical field and over 100,000 patient appointments behind me, I feel qualified to express a few opinions about what’s needed to provide quality medical care. In the early years I recall having more time to talk with patients, research issues and provide counseling for preventative needs. In recent years I find myself hurried, patients frustrated about wait times and increasingly working long hours a day 7 days a week. Given that neither patients nor myself have change, something else has caused the problem. While many minor changes have occurred over the years, the most significant problem is a payment system micromanaged by insurance companies and government regulations. By way of analogy let’s look at two situations that demonstrate how health insurance has become the enemy of good health care – excepting of course insurance for catastrophic situations. Health insurance is complex. Eating out is easy—unless you were to involve your health insurance company. If you hired a third party to pay your restaurant bill, you’d pay twice as much, wait 2 weeks for a table, and have 7 minutes to eat. Perhaps a prior authorization would come up for burritos or a formulary review before a side of noodles, and policy exclusion for desserts in excess of 200 calories. Don’t like the restaurant analogy? Here’s what happens if you used health insurance to cover your automobile. Need oil change? Jiffy Lube has a 10-day backlog until their administrative office can fax State Farm for approval. Flat tire? Soonest appointment at your in-network tire facility is next month. Out of fuel? You can’t stop at Shell or Exxon because Chevron is your preferred provider. If this seems ludicrous, it is. Insurance is for catastrophes, not daily care and maintenance. Car totaled? Call Geico. Fractured femur? Call Aetna. Or maybe Kaiser has the best deal. In the meantime, want to save 40% on routine care? Stop using health insurance for your hangnail. So what’s a person to do? The answer is a direct payment arrangement with your doctor. It enhances the quality of care and patient experience and can save money by managing medical problems before they become more serious and require expensive intervention. Under this arrangement doctors have the opportunity to really know their patients and their history. This provides time to develop solid relationships and to be available for routine check-ups and as a partner in treating serious issues. The key to this arrangement is patient communication, so if you can’t make it into the office we speak via cell phone, video conferencing or e-mail. Communication is what keeps the bond strong and in knowing your medical home will be there when needed. Your doctor needs to be available for routine primary care, urgent care, preventive care and chronic disease management with sufficient appointment time to handle all needs. What you don’t need is a doctor that’s forced to squeeze in an unmanageable number of patients and can instead take the time necessary with you to deliver high-quality, personalized care. Imagine that instead of being shoe horned into a 7-minute appointment, you have time to fully discuss your health concerns and questions. Imagine that your doctor has time to fully reflect on what you have presented rather than being forced to make a quick decision or perhaps referring you to a specialist that will have even less time to listen. Now imagine what care would be like if you and your doctor were in control without an insurance company sitting between you. Most Americans have never experienced this level of care. For patients with chronic illnesses such as diabetes or high blood pressure, the unrestricted access to a primary care physician can have dramatic – often life-changing – positive effects on their health. Health insurance should be used for expensive, unusual, and unpredictable events – not for basic healthcare needs such as primary care. The current insurance infrastructure in the United States actually makes primary care more expensive and less effective. In Huntsville, Alabama, Dr. Neighbors is Board Certified and yet still rather old school in the sense that she remains much closer to the needs of her patient. The underlying motivation is one of the oldest and soundest imaginable – physicians providing patients one-on-one individualized care. As Neighbors puts it, “Just imagine what kind of doctor you could have – and how rewarding it would be – if your doctor could be your doctor all the time, in every context, and you knew that no one else was preventing your doctor from doing the very best for you.” Tell Me More about Concierge Physicians in Huntsville, Alabama. Exit |