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medpundit |
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Sunday, July 21, 2002Supply seems to drive demand. More hospitals in an area mean many more days spent in hospitals with no discernible improvements in health. More medical specialists mean many more specialist visits and procedures. My experience backs this up. My first practice was in a small rural town with limited access to specialists. Patients expected me to take care of the majority of their problems, and I did. They only went to the specialists, who were an hour away, when they really needed them. But now I practice in an area, where there are three hospitals within a thirty minute drive that made US News and World Report’s top 100 hospitals list. To get on that list, they have to have a lot of specialists, and they do. Here, my patients expect to see a rheumatologist for their arthritis, a dermatologist for their acne, and a cardiologist for their chest pain, even if it clearly is not coming from their heart. Just last week I had a thirty year old ask me for a referral to a cardiologist for no other reason than he had a family history of coronary artery disease. No symptoms, no other risk factors. He just “wanted the best.” Part of this is the fault of the medical profession. Dermatologists promote themselves with offerings of “free skin cancer screenings”, then tell the patient to come back yearly for photographs to monitor the changes in their skin. Is this cost effective? Does it decrease the number of deaths from malignant melanoma? Probably not. Hospitals also promote themselves by touting the specialty care they provide: neurosurgeons for back pain, arthritis centers, pain clinics, sleep labs and geriatric centers are all used to lure patients into the hospital system, and all are actively promoted by the hospitals. One hospital in our area has a cancer center that promotes itself by sending out questionnaires to people asking them about their cancer risks. It covers such things as family history and symptoms. After sending in the questionairre, the patients usually get a letter back encouraging them to come to the center for cancer screening and evaluation. The visit is much more expensive than what the same visit would be in their primary care doctor’s office, who is just as capable of screening for cancer as a specialist is. The patient doesn’t really get better care at the cancer center, just the illusion of better care. The medical profession, however, isn’t entirely to blame for the overdemand for medical services. These sort of tactics wouldn’t work if health care were a normal commodity, which it isn’t. Providing and buying health care isn’t the same as producing and buying widgets, and the same market laws that govern widgets don’t apply to healthcare. For one thing, healthcare isn’t really a commodity at all. It’s a need. You might argue that food and clothing and shelter are basic needs, too, and they all operate by the same laws of supply and demand. But, what separates healthcare from these basic needs is that healthcare is a need that people can not provide for themselves. They need the assistance of a physician for it. Always have, always will. Add to that, the natural tendency for people to worry about their health, and you get a market skewed toward demand. If the supply of physicians is there to assuage that worry, then people will take advantage of it. If not, they’ll deal with it with the best means available. This is why carte blanche third party medical coverage is such a bad idea. Give free health care to all, and no one will have an incentive to deal with even the most minor illnesses on their own. Experience also bears this out. I once participated in an HMO plan that did not have any co-pay at all for office visits. Patients with that plan were the most demanding I have ever encountered. They wanted to be seen the day a symptom appeared, even if the symptom was just a sneeze or two. (No kidding.) They also had their drugs covered completely. They invariably demanded the most expensive, latest drug when an older, less expensive one would have done just as well. When I attempted to convince them to use the cheaper medicine, they accused me of trying to save the insurance company money. That plan, not surprisingly, folded. Now those same patients have other types of insurance that require them to pay at least something for their visits and their drugs. They aren’t so demanding anymore. They don’t come in as often, and they don’t want expensive drugs. If we really want to diminish demand, then we have to make access a little harder. To make access harder, we have to make individuals more financially responsible for their health care spending. That’s the only way to control the demand, regardless of the supply. posted by Sydney on 7/21/2002 12:42:00 PM 0 comments 0 Comments: |
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