The Center for Studying Health System Change has a new study regarding physicians in 2008. About 1/3 worked either in solo or dual practices. Thirteen percent worked only in hospitals and 44% of hospital based physicians worked in clinics. It is important to note that 3/4 of physicians in the county are male and in the under 40 years of age group 41% were female. About 80% were full time but 53% of those were over 40 years old. This does not bode well for healthcare access in the future. Physicians were overpopulated n the northeast and under populated in the South. Just under 50% got paid for performance (productivity). Only 25% were on fixed salary without a share of practice revenue. Career satisfaction was more in non primary care physicians and in those with more time in the profession. These also had the most dissatisfaction with medicine. About 30% of practices did not accept new Medicaid patients and only 50% accepted some Medicaid patients. About 90% were accepting privately insured patients. About 75% accept new Medicare patients. Almost 90% of physicians had Managed Care Contracts. There was not a differentiation given between HMO and PPO contracts. About 60% of physicians gave some charity care especially surgeons who were on call.
It took 40 years but there is finally a physician's union at Cook County Hospital, now Stroger. Back in the day I was the urology representative to a committee to get the residents more money. We could not strike so we held a sick in. No patients were discharged so no patients could be admitted. The private hospitals took no Black patients at that time. When Cook stopped admitting patients they had to admit the Black patients. They put severe pressure on the County Supervisors and we got our raise. Top
California HMOs are denying 20% of claims and the State Attorney General is going to investigate them. The denial rates went from 6% for Aetna to 40% for PacifiCare. Even Kaiser rejected 28% of claims. Cigna denied 33% and Blue Cross 28%. These denied claims are for care given in good faith by physicians and hospitals. Top
My main objection to the current bills in the legislature regarding healthcare is that we as a nation cannot afford them. If we were not in a recession my remarks could be different. No matter what the president or his cronies say the reforms will cost the country billions more money. The federal deficit has now hit $1.38 TRILLION and continues to climb. This is a real problem for foreign investment to keep down future interest rates. The projected deficit by the administration for the next decade is $9TRILLION. This is a jump of $2 TRILLION from just several months ago. The massive outgo from the programs now on board is not being met with taxes since they are decreasing due to the recession and unemployment. For the first 11 months of this fiscal year the spending has increased 18% and the income has decreased 16%. All this without the potential for TRILLIONS more for healthcare. Remember, the bill was only supposed to get insurance potential for the now uninsured who want to be insured. It blossomed from there.
The Senate has changed many of the problems with Obamacare. The price is still high but now is about $800 Billion. They have removed the public plan. They are allowing people to buy insurance via cooperatives. They are putting in verification procedures to keep out illegals. The insurers may not keep out pre-existing conditions. There will be no funding for abortions unless for the life or safety of the mother. There will be some med mal changes in certain states as trial options.
Prior to all the above the AMA showed why no one belongs by going along with Obamacare. The reasons are no reductions in Medicare pay and the government paying for millions of people to see physicians. This is how we got Medicare and why Medicare is now in a deep hole. We have always known the AMA were of ill repute, now we know their price, $228 Billion over 10 years.
The Wall Street Journal published a blog from two Brits extolling their healthcare system. They state the two best part of the system are their GPs and NICE. The physicians are trained more deeply in Britain than in the US and therefore take care of more conditions without referrals. (Good or Bad??) NICE is the organization that holds back needed care for individuals unless the cost is less than $22,000 per patient per year of extended life. If it costs more than that it is simply not available and you go to ground and stop using medical resources.
A study by a professor at Harvard states that malpractice litigation only accounts for 2% of the healthcare spending. Of course that is the outlay by the physicians and insurers and does not take into consideration how much money is spent on unneeded tests to prevent the angst of being sued. This is the rub. Cutting back med mal suits and payments in general will not change individual behavior. The physician will still order tests because even though it costs less for insurance and the insurer will pay less, the physician will still have to go through a living hell and possibly be reported to the NPDB.
A study reported in the Wall Street Journal by UCSF showed that if CMS really did not pay for "never events" the healthcare system would save a whopping $1 million to $3 million yearly. Not bad savings in a system that currently pays over $2 TRILLION.
For the third article that nothing will help spending, the Rand Corporation has shown that comparative effectiveness will also not slow down spending. The reason is that if behavior of the physician and the patient do not change there can be no long term savings. Any initial short term savings will be offset by the costs of the research and the dissemination of the information. Top
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