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I don't believe that there is a totally fault-free health system in the
world- guess never was! Although, the human anatomy, physiology and biochemistry
for the current human species has not changed, the challenges have-
population growth with it pollution, man induced anamolies- aftermath of atomic
reactions, biological/ chemical warfares/ accidents/ purposeful experiments,
AIDS, and the recent most SARS.......
However, each government and its people try to address and live in their
health system the best they can. Factors for degrees of success obviously depend
largely upon demographics and socio-cultural factors such as population,
per capita income, education, etc. as well.
My own ideal health system (may not be for others):
- Direct access to all health care providers and facilities- reduce waiting
times or need to see gatekeepers first (healthcare dollars saved)!
- National health coverage for primary care services (my take- family
practice/ GP visits, routine check ups, pediatric visits/ well baby
programs, OB/ GYN visits, rehab visits) to all residents based upon
an income sliding scale- cap the rotine examinations/ visits to disallow
over-utilization by practitioners
- National health coverage for hospitalization for actual treatments
and all surgeries (not cosmetic)- cap the charges based upon number of days in
the hospital, also use factors such as DRGs/ number of patients treated in a
year or clinical indexes in order to discourage increase hospital stays- would
we see lesser unnecessary surgeries, would conservative treatments once again
dominate the medical field?
- Stop the 'monopolies' by these private insurance companies, that are there
mainly for-profit only, instead I don't mind the government putting those
premiums (based upon a sliding income level) toward total coverage. I haven't
seen or heard a single-insurance company say, "Okay, I feel this patient
needs more visits or time for recovery than what you are saying, so here you
go I am going to give you one additional week than what you asked for".
- A 'totally-free' health system may cause a budget deficit or
bankrupt the government and that could well mean reduction
in health spending to accomodate say spending in defence matters, education or
transportation. So, it might not be a bad idea to have people paying in
to it in some form or format
- Malpractice-insurance: Should continue even just to safeguard
practitioners in a sue-happy country such as the US. While,
I also strongly advocate for the consumers to be safeguarded
againsts unscrupulous ones. They should have the right to appeal and collect
for negligency or purposeful harm caused to them. But I donot advocate
mandatory malpractice insurances. If a practitioner for one reason or the
other (e.g. monetary) chooses not to have it- fine; but then be ready to face
the consequences
- Regulated income levels in institutions, will take care of disparity
amongst same level of providers/ discourage other incentives to 'supplement'
income. If I am going to only receive $ 10,000 per month, why run some of
these tests that I know are either redundant or not required? Again, let's not
be naive. While, mostly we have ethical ones out there, we do have too many
venipunctures, X-rays, MRIs going around. Who made the rule to first get
X-rays and then get MRIs (already we have wasted the costs for X-rays, when
the doctor was sure an MRI is going to be needed)! And, again how about a
better qualified practitioner getting lesser paid because he is a 'bad
negotiator' and business unsavvy than the new chick right out of school, with
her good 'marketing' skills?
- Regulation of staffing based upon needs- Hospital gets a grant of X amount
of dollars to cover all routine expenses (maintenance, wages,
food, supplies, etc.)- and is required to have this mandatory staffing
requirement (no incentive to cut costs by one less nurse aide or dietician).
What did you guys think (those in SNFs) about the brief period we had the
'salary-equivalency' period in the US (April, '99 to October'99
or Dec'99, I guess)? The facility needing 2 OTs, 2 PTs had 5 each,
your bosses weren't really caring about productivity...Why? Ofcourse, more the
staff hours more the money! Just before that you had all the push for units,
b.i.d. treatments- why? You got paid based upon the billable time you spent
with patients. And, more the cost shown , more the payment received. So, you
put in travel costs from flying in from upper peninsula to downtown Detroit,
and you still got paid- because, that was your cost. Evals were then charged
seperatedly for at least 8 units (2 hours). And, then came the brief period of
salary equivalency, boom in the therapy business continued, you could demand
your price- a further rise in the admissions to therapy schools as
well..... And, then came the twister (some still splintered with the
aftermath) called PPS. No longer therapy evals were covered, we now had capped
payments with levels of treatment times- evals times suddenly dropped to
15 minutes (wow, sudden effeciency?). You now needed to, ofcourse, take care
of your costs after all you are not getting paid for your costs + premum added
to it, not for the bodies in your practice, so patient time was 'managed',
b.i.ds were suddenly not needed? Staffing got massacred. Capped
reimbursements.... Say what, you suddenly had a massive supply and poor
demand. Therapy admissions took a nose dive, and now with the rates bettered,
profit margins better for the higher categories versus the low nad medium in
the first year- Ultra-high category being lucrative enough, we ofcouse need
people to produce that- let's fill 'em up! WHO IS REGULATING HERE? And,
where is the consumers' choice or what is 'reasonable' and 'necessary' for
them?
- Medicare/ Medicaid/ OIG dollars (governmental health regulating bodies
equivalent in other countries) better spent not to have people reading
notes to deny them but, to empower practitioners to do the right thing and
ensuring that the consumers' are getting what they are warranted for
- Stop needing to waste time on mostly useless note writing practices for
payments.
- Socialistic viewpoint versus capitalistic? I call it consumer and provider
friendly versus 'for-profit only' insurance industry, or 'more profits only'
healthcare practices. Nothing wrong in being 'for-profit', that's need for
a continued existence, but 'only' for profits- as we see many, causes
'losses' to the consumers directly or indirectly monetarily or otherwise
- So Biraj & Jodi, I agree with both of you!
Just my thoughts...
Joe
----- Original Message -----
Sent: Sunday, June 29, 2003 3:55 AM
Subject: Re: [OTlist] Malpractice
Ins
Hi Jody:
Thanks for reading through my post and responding. However, I was making
two basic points. Firstly that universal healthcare at any level
is NOT "hyper regulated socialism". Secondly, that private
for-profit healthcare as it is run in the U.S. is not only a complex maze of
rules and paperwork, but that it is downright dangerous because one can be
covertly denied a required treatment because it costs the healthcare
corporation too much. And I honestly doubt if there is any safe way to
realistically offer quality healthcare in a for profit system.
In fact I am willing to go a step further and say that the whole
notion of competitive for-profit health care where one can shop around for
services is inherently and seriously flawed. Because the basic idea that
one can cut costs (to compete with other health care sellers) and yet offer
standardized quality care is unrealistic as it carries the expectation that
for-profit corporations are going to be ethical and well meaning in taking
decisions which give precedence to standards over profits.
Unfortunately, in my opinion, the idea of being able to shop around for
healthcare as one does for cars can't work because if you did not buy a
Volkswagen or a BMW or a Hummer and simply bought a Chevy Cavalier or Hyundai
Santa Fe - it will still serve the purpose. But if an individual needing
a catscan or an MRI was "carefully" screened based on a 30 minute interview in
the doctor's office (as against a short 10-minute interview which is often
used by doctors) it will not be the same thing. Or if a healthcare
provider is required to see 10 (or 8 or 5) patients for each hour of time
worked one cannot expect quality standards to be maintained, because there is
no such thing as assembly line healthcare.
Please note that I did not take up your example of groceries, because that
is a can of worms in and of itself. However, I am not sure if I can
suitably respond to anecdotal information based on your experience. And
I am sincerely glad that that has been your experience. However, as for
the 10 Million people in the U.S. without healthcare, it may very well be a
higher figure. Take a look at these links I was able to find with a
casual websearch, seems like the figure may well be about 40 million without
healthcare:
http://www.coloradosenate.com/results.php3?news_id=382
The PT Dept. website of Northeastern University:
http://www.ptd.neu.edu/pth1420/medicaid.htm
Ah well!!! Let us agree to disagree Jody.
Take care,
Biraj
[EMAIL PROTECTED] wrote:
Biraj - you have
written a long and thoughtful post. I cannot begin to reply on your
level, but I will respond to a couple points.
In a message dated 06/28/03 9:24:57 AM
Central Standard Time, [EMAIL PROTECTED] writes:
I found that I had to go through a maze of
rules to walk into a doctor's office or avail of a health
service.
<<<<< I too have found that as a health care
consumer. But its not that I think our current system is good or that
it is a good example of the free market at work. Its not only
that I don't want Medicare and Medicaid to morph into Canadian style health
care, its that the whole US system is already broken. The health care
consumer has little incentive to adopt a healthy lifestyle to save on
medical costs. The health care consumer has no incentive to shop
around, since the costs are almost always paid by a third party, whether
government or a for profit insurance. I am not advocating
that the current US system is superior to Canada. I am saying I want a
new system in the US, one where consumers buy healthcare like we buy cars
and groceries. My vision is for a system with no third party payers
for any expenses under say 10K per family per year. Something like the
medical savings account concept, not tied to employment. This is
a system which allows the consumer to set aside pretax dollars into an
account to pay their own health care expenses. ( Sometimes called a health
care IRA because any money left in the health care account later can be used
for other needs. It is combined with a high deductible insurance
policy to pay for really catastrophic illness. This would put the
consumer back in the drivers seat. Those hassles, and that maze you
mentioned, we don't deal with a hassle or maze like that when we buy a loaf
of bread or even a car, do we?>>>>
To give one recent statistic, I
forget the source (but perhaps it was "60 Minutes") there are 30 Million
people in the U.S. who do not have access to
healthcare.
<<< I say
hogwash. There may be 10% of the population uninsured, but most of
these are young and healthy and intentionally have decided to go bare rather
than pay the high insurance premium. Furthermore, I live in the ninth
poorest county in the USA, one journalists like to compare to the third
world, and I don't meet anyone who cannot get health care. All US
hospitals are required to treat emergencies. Also, actual cash can
still work in the health care system. My husband and I have been
raising 4 kids for the last 15 years with insurance that has a $3000 per
person or $10,000 per family deductible. Guess what ? Our kids
have had the usual assortment of broken bones, colds, flus, tubes in the
ears, two (one night) hospital stays, and we have used our insurance
once. We have (gasp) paid for all those doctor, lab, drugstore,
and hospital bills. And now we are starting braces on 2 of our
kids. >>>>
Sorry if I am
ranting. This topic is close to my heart. It rarely crosses over
with the OT topics, and I know most OTs seem to be Democrats so I usually
don't get off on these topics. -- Jody
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