Monday, October 6, 2008

The business of medicine

Sometime between my first day of medical school and entering private practice accountants arrived on the scene changing the practice of medicine into the business of medicine. Caring physicians became more interested in reimbursement than in the patients sitting in their exam rooms. More ancillary personnel were hired, not to facilitate patient care, which was now secondary, but to bill and collect money from insurance companies which are the real consumers of health care services.

In 1929 at the hospital where I currently practice, the first health insurance plan was fashioned to allow school teachers to spend 21 days a year in the hospital if they became ill. The cost each year: Six dollars a teacher. In a time of rather unsophisticated technology Blue Cross and Blue Shield of Texas easily turned a profit. From this humble beginning the health insurance industry has grown to a to a multi-trillion dollar business demanding a larger and larger portion of the annual gross national product and making health care outrageously expensive for those who pick up the tab.

Patients and providers alike are complicit in this growing problem. Patients schedule innumerable visits with physicians asking for every avaliable test because the health care premiums are a benefit provided by their employers. Little thought is given to the real cost or the real need when all that is required of the patient is a twenty dollar copay. What else can be purchased for twenty dollars today? The real cost is often hidden from the patient who pays little attention to the cost of the health insurance or the true charge for a visit. Health care providers are happy to serve the consumers with unnecessary tests and procedures increasing revenue but not necessarily improving health.

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