Sunday, January 02, 2005

Who Does a Doctor Treat?

This comment was posted on DB's Medical Rants:

As one from the “payer” side, I’d recommend we take the argument on health care costs a step further. Like it or not, employers pay a significant portion of health care costs, both directly (premiums) and indirectly (cost-shifting for uninsured, FICA taxes, income taxes, etc.)
The real issue employers have with health care costs is they have NO sense for their return on the investment. And that is the fault of the medical and managed care communities. Employers carefully assess each investment into plant and equipment, personnel and training, investment options and new products. They calculate RoIs carefully, assess performance constantly, and get as comfortable as possible with an expenditure BEFORE they make the investment.
Think about health care - what do employers get? Happy employees? Rarely - health insurance is a terrible “good” - people only use it when they are ill or injured, it is convoluted and difficult to understand, and they have topay for part of it too!
Actually, what employers SHOULD be thinking about is the demonstrated ability of a health care provider to “deliver” healthy, fully functional employees and families, thereby enhancing productivity and, therefore RoI. Health insurance is an investment in productivity.
If we can evolve to this way of thinking, much of the present bickering about health care costs will end. Sure, there will be arguments about impact rates, who delivers what benefit, and what evaluation methodology makes the most sense, but that will signal we are talking about the right things.
So, the next time someone complains about charges, costs, or premiums, ask them how that “good” will help them function. They won’t know the answer, but perhaps they’ll start thinking about it.


I see patients one person at a time. My duty is to the patient, not their company. The individual patient is the one who signs a form agreeing to accept the responsibilty for my bill. There are occasional exceptions (I recently did a Workers Comp Eval in which I received payment directly from Workers comp; before the eval I informed the patient that I was providing services to Workers Comp and not him and obtained informed consent before proceeding with the evaluation). In most cases, doctors have relationships with individual patients, not companies or businesses. Although businesses do pay for much of healthcare in this country through health insurance premiums, this is at the expense of higher wages. So ultimately, it is the worker who is paying.

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