So, I was thinking about switching doctors...

[unixronin]

...since my current primary care physician is in South Nashua, 20 miles away now.  Dartmouth Hitchcock has a family practice facility right here in Merrimack, and my podiatrist is already part of the Dartmouth Hitchcock system.  On top of that, it turns out one of the doctors at the Merrimack family practice center is an osteopath, which might well mean I'd be able to find more effective care for my back problems.  (I think half the reason chiropractic treatment is viewed with such suspicion in the US is because it's so hard to find a chiropractor who isn't, frankly, a complete quack.)

Well, so much for the theory.  The practice is that the osteopath isn't accepting new patients, and the only doctor there who IS accepting new patients is currently booking appointments in early January.  This suggests that the facility is so overloaded going there might be a bad idea anyway.  I wouldn't be able to get any of my referrals transferred until after a new-patient appointment, and then there'd be the queue lead for the specialists, so the upshot of it seems to be that if I switch to a PCP at Dartmouth Hitchcock Merrimack, it's going to be five to six months before I can get any care from any of my specialists again.  (And frankly, I think I need to get my right knee cleaned up the same as the left knee as soon as I can.  The crunching noises are starting to get really unsettling.)

It's at times like this that I reflect on how screwed-up the US medical care system is.  The whole "all your referrals reset if you change doctors" thing is a pain, and when it's so hard to find a doctor who's accepting new patients and isn't totally swamped, what do you do?

Half the problem, I suspect, is the number of doctors who've retired or gone into other lines of work because they can't afford malpractice insurance rates driven by frivolous malpractice suits (parents suing their obstetrician because their child was born with a congenital defect, for instance¹).  Unfortunately, that's not going to change as long as the perception of a career in law as a get-rich-quick license endures.

This country needs twice as many doctors and engineers, and a quarter as many lawyers.

[1]  This isn't a hypothetical example.  I've read of several cases in which a child was born with what was unquestionably a congenital defect, but the parents sued the obstetrician anyway, and the obstetrician's medical insurance settled out of court because "We all know this is a congenital defect and there's not a thing you could have done to prevent it, but the instant a jury sees those photos, we've lost the case."

Comments

[skellington.livejournal.com]

Note that my insurance plan doesn't require referrals, and this is entirely a factor of how good your particuliar insurance plan is.

Some are, of course, more trouble than others.

[unixronin.livejournal.com]

Who is your insurance carrier?

[skellington.livejournal.com]

It is managed by a company called Gilsbar, through a preferred provider network called Southcare. Our company is self-insuring, however, so I'm not sure how that plays into it.

But I don't think I've had to do referrals on any of the last 3 or 4 plans I was on. In fact, Kaiser was probably the last that required it, which was 1995 or so.

[unixronin.livejournal.com]

We're with Harvard Pilgrim, and we have to have referrals for everything.

[laurarey.livejournal.com]

It's interesting to hear your reflections on US healthcare. Since moving to Canada, I'm much more aware of the differences and similarities between the two countries' systems.

I think the biggest contention has been when Canadians state, "We have universal healthcare for all....and you don't have to pay." Ahem. Me thinks the extra 10% in taxes I'm paying contributes to the healthcare system. However, they are right. You, theoretically, can get healthcare here. Quality varies, and heaven help you if you don't already have a primary care physician. Finding one that is taking new patients is all but impossible.

However, I've been in the hospital a couple of times and there were no charges....which was baffling to this poor American. When I checked in the first time, I took my credit cards with me. *laugh* They couldn't figure out why.

We still have insurance to cover those things that the system doesn't cover...chiropractic care, eye care, dental care.

The worst situation is MRI's. Need a catscan or xray? No prob. How about Tuesday at 10. Need an MRI? How about next July? Many folks, who can afford to, simply go to Buffalo for MRI's. My friend was diagnosed with some sort of tumor/growth in his brain. He would literally have had to wait six months if he hadn't gone to Buffalo and just paid for it.

So, I'm not sure either system works perfectly. I just find it interesting to hear similar complaints from both sides of the border.

[beckyzoole.livejournal.com]

I've heard from a few different sources* that it's not the lawyers who are driving up the malpractice insurance rates, but the insurance companies. That is, in states that have instituted severe control over malpractice suits, limiting who can sue and when and for how much, the cost of medical malpractice insurance has gone up just as much as in states that haven't imposed these controls. In the meantime, insurance company profits are going up and up and up.

* No cites available now, but I'm sure I could find them if you're interested.

[unixronin.livejournal.com]

Oh yes, that's definitely part of the problem -- medical insurance providers whose primary focus is on generating maximum profit from providing medical care, not on providing the best medical care and covering the costs. It is my considered opinion that all medical insurance companies and medical facilities should be required and compelled by law to operate as not-for-profit organizations. In any nation that calls itself modern and civilized, it is an unconscionable thing to have to ask the question, "How much health can you afford?"

[ithildae.livejournal.com]

In the Great State of Minnesota, all health insurance companies are required by law to be non-profit. It really does not make a difference.

Part of the problem is the shortage of Nurses, that is driving up costs in many areas. We have a glut of Doctors, so their direct costs are going down. Health care and insurance is such a convoluted branch of economics that it is difficult to understand what is happening. And harder still to figure out how to fix it.

Old saying: One lawyer in town goes broke, two lawyers get rich.

[novel-tharkun.livejournal.com]

I'd have to largely disagree. Though I like the thought in your comments that medical insurance should be not-for-profit (I'd prefer non-profit).

I think the largest problem is not lawyers, doctors leaving the field, or even malpractice insurance maximizing profit (though obviously that's a significant part). The legal aspect that the insurance companies would rather settle things quickly and quietly, than fight and win, since that produces less exposure, increased rates from the doctor, and likely less overall costs.

The largest factor appears to me to be that the doctors require insurance from patients, as cash patients pay higher rates (no negotiated discounts). In the meantime, insurance companies clamp down on repayments, refuse tests without excessive justification, and know that they're costs will be recompensed because the system is built with them inside.

To solve this, we need to find a way to build a system that doesn't have insurance as a requisite cost for everyone at every level.

p.s. PPO plans often do not have referrals necessary, in my limited experience. Depending on the number of doctors in your area, this might not help as you still can't get an appointment without a secondary doctor requesting it.