Saturday, May 02, 2009

Too Few Primacy Care Doctors Means What? Reform #4

Health care reform will likely require people to purchase health insurance. Those with few resources will get government help to pay for coverage. The program may be phased in over a multi-year period. What are the implications for citizens and doctors in light of the primary care shortage?

Tom Green County has roughly 30% of the population without health insurance coverage. We have 5% unemployment, so it's not that people aren't working.

While San Angelo has over 150 doctors, it serves a huge geographic region. Most physicians in town are specialty trained. Virtually all primary care doctors don't accept Medicaid, state supplied coverage for the poor. Most aren't taking new Medicare patients. Doctor supply is constrained without giving over 25,000 uninsured patients insurance.

Esperanza Health & Dental Centers, the local community health center, accepts new Medicare and Medicaid patients. The Wyden-Bennett bill steers patients to such centers through their HHA's and HAPI's. HHA stands for the Healthy Help Agency of a state. HAPI is the Healthy American Private Insurance plan.

Should Wyden-Bennett pass, uninsured individuals would have two years to buy insurance through a HAPI. If they fail to do so, a local provider will be forced to report them when they present for care. The HHA will fine the offender 15% of unpaid premiums based on the length of time the person didn't have the legally required coverage.

Overworked and stressed primary care physicians will have to turn in un-HAPI patients? The system will have a new group of uncovered patients who avoid the health care system, those fleeing from government mandates.

Doctors in under supplied areas will continue to pick and chose patients based on desirability. My internist suggested he would limit his patients to healthy ones under coming pay for performance plans. Primary care doctors don't do procedures. P4P will come based on clinical indicators, BP under control, health screenings up to date, blood sugar normal, etc. Healthy patient in, not much in the way of challenging work, optimized payment, and healthy patient out. We may have a health care system that screens out the sick.

Europeans must be laughing at the complexity of America's solutions. Incentivize here, penalize there, and ignore the key variables that serve as the foundation of our health care system. It occurred on Wall Street, where credit default swaps were supposed to reduce risk. America pays for our leaders' ignorance.

Update 6-30-11:  As for a P4P health care system that screens out the sick, consider how Medicare pay for performance has doctors "managing" their patient panels. It's also known as discrimination.

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