THE CURRENT STATE OF HEALTHCARE

HOW IS MEDICAL CARE NORMALLY DELIVERED IN AN INSURANCE-BASED SYSTEM?

Most Americans do not realize that they have options in their health care.  While large corporate medical practices dominate the medical landscape, not all people are happy with how these systems of care function to provide primary care and personalized health care.

Most large corporate medical practices operate on the premise that those who rely on them will have medical insurance.  Those with medical insurance often see no charges at any particular visit or are charged, at most, a "co-pay."  Those without medical insurance often will need to bear the full charges of any particular visit or service, which is often three to five times the amount of the "co-pay."  In some cases, with situations requiring extensive work, a payment plan needs to be set up because the entire bill cannot be paid at one time.  Therefore, the patient/family is instantly in debt!  At first glance, this may be one reason why those without medical insurance avoid corporate medical offices or do not seek care at all (which can often lead to catastrophic outcomes).

But even if you are fortunate enough to have health insurance, are you satisfied with where your health dollars go to provide you with that level of financial protection?  Many do not realize that the large health insurers are profit-driven companies with thousands of employees and that a large percentage of your premiums go to pay these employee salaries.  So there is a tremendous "middle man" component that never goes to paying your health care bills.  Is this an optimal use of your health care dollars?

The same thing can be said for large corporate offices.  I can personally attest to the fact from my time at a Family Practice office in Vermont in which I worked for 19 years that for 5 doctors/providers, the office needed up to 15 additional people to "keep the office running smoothly."  Of course these costs were passed on to the patients in the fee-for-service costs that they saw.  If you were fortunate to have health insurance, you probably didn't notice this, but if you did not, your fees helped pay the salaries of all of these people.  Is this an optimal use of your health care dollars?

THE CHALLENGE OF A PRIMARY CARE PROVIDER AND ACCESS TO CARE

Have you developed a good relationship with your physician, nurse practitioner, or physician assistant?  Unfortunately, having health insurance does not guarantee that you will be able to find a primary care provider.  My wife experienced this recently as it was very difficult to find anyone accepting patients in the primary care "realm."  It is important to have a primary care provider who knows you well.  It is very frustrating to see different persons in your primary care journey with none of them really knowing your history/exam completely.

An extension of the concept of the primary care provider is the concept of "access to care."  How easy or difficult is it to get in touch with your provider for advice, and then how easy or difficult is it to get an appointment (of any type) with that person.  How often have you had to abandon trying to access care with your primary care provider to seek care at an urgent care center or emergency room?