Caveat emptor is the Latin phrase for "let the buyer beware." We all know that when we go into a store to buy a 1/2" wrench we would rather not have a salesman talking us into buying a $300 chest of tools. Buyer skepticism works fine to a point. If we are wiring a dryer, however, it would be a good idea for the sales staff to keep us from buying 14-guage wire when the dryer requires something much heavier. It is necessary to realize when we are buying objects of preference and when we really need to buy expert advice.
When it comes to medical care, our doctor is supposed to keep our overall health needs in mind, and then prescribe the tests, procedures and medications to get us there. However our medical funding system is at war with some of this altruism. The government is afraid of funding "whatever it takes" so consequently it funds mostly doctor visits, medical tests, and hospital expenses things that can hopefully be tied to "really being sick " Drugs are usually left up to private plans to fund but private plans are becoming more commonplace.
In response to the needs of the public, and the desire to make an income suitable for a highly skilled and trained professional, doctors have had to learn to play the system. Since visits are paid for, clinics now provide multiple rooms where patients are lined up in advance of service. The doctor moves from room to room, opening files, spending 15 minutes or so, then moving to the next room. I have heard that some doctors even restrict the number of questions a patient may ask in one visit. As result you may have to try pain killers after visit one, blood tests after visit two, CT-scans after visit 3, etc, sometimes ending in a referral to a specialist who may repeat some of the procedures. Medicare billing takes place at each billable stage.This may be efficient in some ways but is counterproductive because this system makes poor use of the diagnostic skills of physicians who might be able to shorten the path to diagnosis.
For example, in Britain a Nursing-Times.net article reports that 35% of the children found with type-1 diabetes are diagnosed after they have had a "Diabetic Ketoacidosis attack," and may have fallen into a coma. This is disconcerting when the symptoms of diabetes are so obvious, and the testing so cheap and effective (a simple urine-sugar test will usually suffice). The writer met a nurse from a remote Northern Saskatchewan reserve. She bragged that she never missed diagnosing a diabetic patient because a test was administered during each visit. However our medicare system will not fund more for general questioning and possibly unnecessary general examinations.
One physician told me that he could not counsel a patient to quit smoking unless he wrote down that he suspected a respiratory problem of some sort or another. Our system is not designed to help us eat properly, exercise enough, and avoid substance abuse; even though a huge part of our medical expenditures are a direct consequence of one or more of these problems.
The Solution: Structure Medicare so that it progressively starts dealing with wellness instead of illness. Have a research team determine a set of health and wellness predictors: factors which correlate well with general health, so that the cost of sickness overtime will be reduced.
The indicators would have to be ones that could be easily accessed without intrusive procedures such as.
- Chronic conditions already diagnosed
- Body height and weight
- Smoking vs non-smoking
- Blood pressure and pulse at rest
- Age factors
- Lung capacity and strength
Some percentage of an annal budget would come from aggegrate "risk numbers" and another percentage for traditional billing-by-visit and procedure. If there were an average risk number of 7.0 with 500 patients, the clinics risk budget would be based on an aggregate number of 3500. That would be multiplied by a dollar figure set on the government side.
Every year the client base would be "re sampled" and numbers reset. Here is where an incentive program intervenes for those clinics showing positive results. Those clinics showing a decrease in risk number would be provided bonus funding to allocate according to a local profit-sharing plan. Naturally new patient risk numbers would be used to calculate new budgets but not the bonus figure.
Any insurance salesman knows that when you lower the risk factor for a population, the insurance money required to service the accounts goes down. The more successful clinics become at lowering risk, the more bonus money they would receive, and the more Canadian health risks and costs would decrease. Creative clinics would make long term plans. Some would make alliances with exercise clubs, and alternative health providers that can show results from their services. In the meanwhile funding for basic ongoing procedures would continue but common sense dictates it would go down over time. The attitudes of the medical system would begin to change.
When seeing you the doctor would begin to make assessments on two levels: immediate and long-term needs. A doctor might spend additional time with an allergy patient instructing them how to block allergens from entering the home, or referring them to an air-conditioning expert who could assist. The good ones do so now, but they are made poorer when they act in good conscience The doctor might want to influence the likelihood of high-risk pregnancy, or the dietary problems evident with a patient. Progressive clinics might welcome the addition of space for exercise classes or physiotherapist. In the way that "water seeks its own level" medical clinics would shift and adjust practices to produce wellness results.
Funding for such a program should be progressive, with long-range index-related funding being phased in. Over times some clinics achieving positive results would find their practices spreading, some may wish to franchise their clinic design if results could be linked to the design factors. In any case the real decisions for how to improve health care would be in the hands of the professionals who know best, the government and the people would manage core resources according to its vision of what being healthy really means.
