According to a new study in Health Affairs, more than half of the 354 million doctor visits made each year for acute medical care, like for fevers, stomachaches and coughs, are not with a patient’s primary physician, and that more than a quarter take place in hospital emergency rooms.
The authors of the study pose a significant question about what we’re calling “healthcare reform” -- how can access to primary care be improved when an already stressed system with a dearth of primary care physicians takes on millions of new patients?
More than half of acute care visits made by patients without health insurance were to emergency rooms. That poses a heavy workload and financial burden on the system and means that basic care is provided in an expensive setting.
According to Dr. Stephen R. Pitts (no relation), the lead author and an associate professor of emergency medicine at Emory University, “More and more patients regard the emergency room as an acceptable or even proper place to go when they get sick.”
The study can be found here.
In theory, the new federal law is designed to enhance primary care by increasing reimbursement for practitioners, luring students into the field with incentives.
The real-world reality is, as we know, quite different. I recently went to my Upper West Side Jewish GP (just to give you an idea of the non-Tea Party demographic). She asked me, “So, how bad is it?” When I asked what she was referring to she said, “This new health care law – for me.” The concept that you can improve primary care by (1) restricting the independence a physician has to practice both the art and the science of medicine and (2) sending very mixed signals about the inevitability of a permanent “doc fix,” (3) increasing case loads, and (4) doing absolutely nothing about tort reform – certainly makes a dubious case for “luring students into the field,” let alone keeping those already in place in practice.
The authors issue a critical warning, “If history is any guide, things might not go as planned.”
And those who do not learn from history ...
And speaking of tort reform, another article in Health Affairs illuminates addresses the issue head on.
The paper by three Harvard professors and a colleague at the University of Melbourne in Australia estimates that the medical-liability system added $55.6 billion to the cost of American medicine in 2008, equal to 2.4 percent of total health spending.
More than 8 of every 10 of those dollars — $45.6 billion — was attributed to defensive medicine by physicians who order unnecessary tests and procedures to protect themselves from malpractice claims. Not decimal dust.
That study can be found here.
Attention must be paid. Whoever has the gavel for the 112th Congress has a lot of work to do.
