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    Monday, November 01, 2004

    Kaiser Rhapsody: Is Kaiser Permanente the future of American healthcare? It sure sounds like paradise:

    After 18 years in private practice, Dr. Victor Silvestre was exhausted from his lonely battle, day after day, with a health care system that seemed to be working against him. A general practitioner, Dr. Silvestre found it increasingly difficult to get his patients appointments with specialists, who tended to focus on lucrative procedures instead of routine care. Paperwork and haggling with insurance companies, he said, took more and more time. 'There just had to be a better way,' he recalled.

    For Dr. Silvestre, the better way was not across the border in Canada, or in some affluent nearby suburb, but in his own backyard, in Oakland. Two years ago, he joined Kaiser Permanente, the huge health maintenance organization based here. 'So many of the solutions, the ingredients of a more rational system for delivering health care, were there,' he said.

    Dr. Silvestre does look happy in that picture. Look, he even has time to shop for tomatoes. Although, not too much time. He didn't have time to take off his lab coat. One of my on-call partners fled Kaiser for a traditional practice. He hated it. The paperwork and administrative hassles were part of the reason, but he also disliked the constrained environment. His treatment had to stay within rigid guidelines, no room to tailor it to the individual patient. And continuity of care, surprisingly, was a problem. When a patient calls Kaiser for a sick appointment, at least around here, they're given an appointment with the doctor who is on duty for sick calls that day - not necessarily their own doctor. And if they're sick, but want to come in tomorrow- not today - they're told to call back tomorrow for an appointment.

    What I see when I review the old records of my patients who have transferred from Kaiser is pretty good preventive care, but overall care that is very disjointed. And despite what the article says, Kaiser is very much the grandpappy of the HMO's. Didn't we try that in the 1990's and find it to be extremely unpopular?

    The innovative programs the article mentions - management programs for chronic illnesses such as heart disease and diabetes - are already in use by other insurance companies. Most of my patients have enthusiastically signed up for these in areas as diverse as depression management to asthma management only to have their interest dwindle with time. They all end up complaining about the "nagging phone calls" that are an inhrent part of those programs.

    You'll notice that all of the glowing comments about Kaiser in the article come from health policy analysts and experts. What do the patients think? Not much.

    posted by Sydney on 11/01/2004 07:21:00 AM 1 comments


    Refer to Diabetes for
    useful information

    By Anonymous Anonymous, at 6:57 AM  

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