[FoRK] Poverty In America: A Special Report

Gregory Alan Bolcer greg at bolcer.org
Tue Sep 27 09:49:04 PDT 2011

I don't disagree, but I consider financial billing, inadvertant charges, 
and overpriced goods and services as all secondary effects from the 
primary one:  people end up seeing doctors when they don't need to. 
It's just like convenience shopping at grocery stores, they know once 
you get into the store, purchases are made at 40% more than you 
otherwise would have 'as long as you are there'.  There's no getting 
around human nature either from the dr's perspective or the patients.

Widely reported today: "Our findings show that many primary care 
physicians believe there is substantial unnecessary care that could be 
reduced, particularly by increasing time with patients, reforming the 
malpractice system, and reducing financial incentives to do more."

And why are those goods and services overpriced?  I quote Forbes:

> Doctors pocket about $20 for each Medicaid patient they see. By contrast, an hour with a privately insured patient means payment of up to $260.
> To compensate for lower government rates, doctors must increase their patient load. Every patient consequently spends less time with the doctor.
> In some cases, doctors are responding to low reimbursements by refusing to see patients with public insurance. The American Academy of Family Physicians found that 13% of doctors did not partake in Medicare in 2009.
> The numbers are even worse for Medicaid. The Houston Chronicle reported that doctors in Texas are leaving the program because of declining reimbursements at an “alarming” rate, with more than 300 drop-outs between 2008 and 2010. In Dallas, just 38.6% of physicians participated in 2009.
> Given the paltry amount they’re reimbursed for seeing a Medicaid patient — and the cost of overhead — a doctor may actually lose money on each additional public patient he or she sees.
> As the number of doctors who will treat them dwindles, beneficiaries of public insurance often must resort to costly alternatives like emergency rooms (ER) — even if they only need routine care.
> More than 30% of Medicaid enrollees visited an ER in 2007, compared to the less than 20% of Americans with private insurance.
> These visits exert a huge burden on the U.S. health care system. A 2009 study in the Annals of Internal Medicine found that treatment for three common illnesses cost an average of $166 at a general practitioner’s office. The very same treatment could run upwards of $570 in an ER.
> Up to 27% of visits to ERs across the country are for non-emergency medical treatment. These unnecessary visits end up costing the country approximately $4.4 billion each year.


On 9/27/2011 9:35 AM, Reza B'Far (Oracle) wrote:
> Hmm... I have to agree with Adam. I can dig up stats, but supply-chain
> issues are the biggest issue. They dwarf all other costs. Supply-chain
> meaning simple financial billing stuff like unbundling of charges from
> providers to payers, inadvertent over-charges, and more complex things
> like overpriced goods and services delivered to patients by service
> providers.
> Unfortunately, the issue with studies, etc. is that there is no
> conclusive source. I think in the health-care ecosystem more than any,
> there are so many folks who depend on the waste in the supply chain
> (given the numbers are so large) that it is near-impossible to
> stream-line processes, cut-out-middlemen, etc.
> On 9/27/11 9:24 AM, Gregory Alan Bolcer wrote:
>> Everyone complains about billing, fraud, and bloat.
>> The biggest cost in healthcare? One of every 10 patients doctors saw
>> daily had issues that could have been dealt with by phone, by email or
>> by a nurse.
>> There's 10% right there.
>> On 9/18/2011 7:53 PM, Adam L Beberg wrote:
>>> A huge part, if not majority of costs are due to billing and bloat.
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greg at bolcer.org, http://bolcer.org, c: +1.714.928.5476

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