Health Care Reform

Fed chairman Ben Bernanke recently released a statement regarding health care reform. In the next few posts we share opine regarding his conclusions.

The first challenge Bernanke identifies is that of access. By this he means access to decent health care. He seems to believe that this is the same as being uninsured. It is not. Those who are uninsured most certainly have fewer choices in their health care. The care they receive is, unfortunately, inferior much of the time.

What Bernanke fails to mention is that insurance does not reliably prevent this. Even patients with “good” insurance may have limited choice in physicians or care. That’s because there are economic reasons why a physician may choose not to take a particular insurance or refuse all insurance. For instance I currently live in an area with very few dermatologists. At last count NONE of them are on the majority of local insurance plans. To find an “in-network provider” I must drive 200-300 miles.

The eventual outcome will be a nationally run, single payer system. There is no alternative that will prevent companies like United Health Care from diverting premiums from both share holders and patients into illegal payment to greedy executives. Fat cats like William McGuire, former CEO at United should be paid at rates similar to physicians. (For more interesting perspectives on McGuire and health insurance click HERE.)

Certainly the government has some waste and corruption (to view Dr. McGuire’s political contributions click HERE). But the amount of money paid to physicians pales compared to the rampant profiteering by for-profit health care corporate executives. (Remember only 20% of health care cost is attributable to physician compensation- the rest goes to hospitals and administrators like McGuire).

In the future, we’ll look at other proposals and ideas from Bernanke.

It’s your health take part and take care.

Dangerous

It’s very hard to know how good or how dangerous your physician or your hospital is. That’s because the information available to you is not adequate. Some companies are trying to change that. But before you plop down hard-earned cash for the services use free services first.
1) State medical boards- every state maintains a database of licensed physicians (and other healthcare providers as well). Before you go see a doctor you should check him/her out throught the medical board. In most cases the information is readily available online either for free or for a nominal fee. You can find disciplinary actions and other useful information. After all wouldn’t you want to know if your physician was prohibited from seeing patients without a chaperone?
2) The Better Business Bureau in many areas has information regarding physicians- but it’s probably not reliable.
3) Word of mouth. Unfortunately this is some of the worst information. The reason is the patients generally don’t know wether their doctor is any good. Instead they often base their opinions on “hotel services” those characteristics of warmth and friendliness which may not correlate with actual medical skill or knowledge.
4) Certification agencies or boards- your doctor should be board certified. He/she should be able to tell you this and it should be displayed proudly in his/her office. Non-board certified doctors may be perfectly good physicians, but wouldn’t you rather know your doctor has had specified post-graduate training and passed a standardized exam?

There are also organizations that maintain and distibute information about hospitals. One of the best is Hospital Compare run by The Department of Health and Human Services. It’s free and gives good objective information regarding your hospital’s performance. You should definitely ask your doctor or hospital administrator about issue that concern you. The availability of information is increasing steadily. Take advantage of it.

It’s your health. Stay informed. Take charge and take care.

Aggressive Care

Evidence-based medicine. The very words send shivers down the spines of many physicians. Modern medicine, in the US, is based on unequal information. Doctors know “stuff” they charge patients to find out. Very few patients know anything about their physicians except whether the physician is nice to them and they get better. Many, if not most, patients would get better on their own so in essence physicians are really judged on a “niceness factor” much like the server at McDonalds.

Physicians order tests for a variety of reasons. They fear litigation. They’re trying to meet patient expectation so they don’t lose market share due to an adverse “niceness factor.” They’re just not very smart and they figure another test might “clue them in.”

Recently physicians at Dartmouth have completed a study that indicates that more aggressive studies and care are not necessarily beneficial. That’s not particularly surprising since we spend more percapita than any other country yet have little objective evidence of value to the care we provide.

For example, many years ago I worked at a well-known tertiary-care children’s hospital. Some of the pediatricians had profoundly impaired patients with “static encephalopathy” from a variety of causes. At least once a day I would provide anesthesia for one of these children for an MRI of the brain. On several occasions I asked the pediatrician “What will you do if the MRI looks better but the patient is the same?” Few of them understood the question and none changed their ordering practices-. The reason, if that pediatrician doesn’t order the test the parents will simply find a physician who will- the pediatrician failed the “niceness factor.”

So what does this mean to patients? Ask your doctor what each test and medication is for. A test which only “confirms” what he already knows doesn’t help it only costs. Do not let fear of the remote possibilities overwhelm your judgment. This also means you need to choose you physician based on skill not niceness. You’re physician should be board-certified and have a clean medical board history.

Only use the care you need. Make sure the care you get is effective and cost effective. More care is not better.

It’s your health. Take care. Take charge.

Medical Records

Medical records have become a hot topic lately. The biggest reason is the compromised records of prominent persons in California.

But your records are just as important. They’re important to you because your doctor uses them to track your health and plan therapy. They’re important to you because you want coordinated health care. They’re also important to you because they contain confidential information related to you and your health. Compromise of these records may compromise your identity as well as your health. You should always ask you physician how he/she manages record security.

But now Google want to enter the medical record business. As Google goes so shall others. Storing medical records on-line holds the possibility that your record can be available anytime and anywhere. This also raises the possibility that your confidential information may be compromised more easily.

It’s your health. Take it seriously and take care.