The Reimbursement Crisis in Medicine – Are We Shooting Ourselves in the Foot?




Opinion.jpgIn this era of declining reimbursements, I’ve been thinking a lot about socialized medicine and how physicians can stop the bleeding. It’s clear that reimbursements cannot go lower for many physicians. If they go lower lots of docs simply won’t be able to run their offices anymore.

While the cost of healthcare continues to increase and insurance companies want to cut costs, the total cost of care needs to be looked at. If an insurance carrier has X dollars to spend on a surgery or on an office visit, the each piece of that procedure or visit must be looked at. If a physician prescribes expensive new medicines for a patient, he may be doing the best thing for the patient. If the medicine is not yet proven and costs significantly more than the standard of care, he may be doing a disservice to the economics of medicine.

When a surgeon uses the latest cutting edge technology that is demanded by the patient, he is contributing to the rising cost of health care significantly. Some implants and devices actually cost more than the surgery and entire hospital stay! In some sense, the surgeon may be taking away from his own pay because he wants to use the expensive device.

Thus, if there are X dollars for the surgery, it simply may be in the best interest of the patient, physician, and hospital both from a standard of care and from a financial perspective. If extreme vigilance and pragmatism is used in the selection of drugs and devices, the clear loser is profit-driven industry.

Many people say that the American people will never accept a system that doesn’t allow choice of new drugs or devices. Perhaps a system where the patient is the consumer and must pay extra for a specific drug or device will work. After all, everybody these days seems to be willing to pay extra dollars for the latest car or cell phone. Maybe we are all willing to pay for the newest surgery or newest drug as well.

JC, MD

Dr. JC is a medical doctor who has a passion for health promotion and education.
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