Sunday, January 3, 2010

Doctor Shortage- More Insurance Does Not Mean More Care

Health Reform Plans as Buses to Nowhere

Before the Christmas break, federal legislators were talking about health plans as offering “bus tickets” to the uninsured but with no buses running on routes for the uninsured.

Health and Human Services (HHS) estimates the U.S. is at least 16,000 doctors short for serving 256 million Americans who are now insured. That shortage will surely grow if 30 million more uninsured Americans board health care buses. These buses may be buses to nowhere.

Massachusetts is an example of the busing problem. With its universal coverage plan, now four years old, 97 percent of Massachusetts citizens now have insurance. But more that 25 percent have a hard time finding a doctor. And this in a state with the second higher number of doctors per capita of any state in the land.

To boost the physician supply, these are suggested solutions.

• Increase Medicare-funded residency slots by 15,000, thereby making it possible to produced 40,000 more doctors by 2019.

• Expand medical school enrollments by 30 percent, already underway.

• Double the number of National Service awards to primary care and general surgeons and pay their medical school tuitions if they agree to practice in underserved states.

• More fully integrate nurse practitioners and physician assistants into practices by having them take care of uncomplicated cases.

• Create medical homes whereby primary care doctors can offer more coherent, collaborative, and comprehensive care or those with chronic disease.

• Increase the number of community clinics to care for Medicaid and related populations.

• Reduce the “hassle factors” – administrative burdens and paperwork – by simplifying forms, and freeing up doctors to treat patients rather than treating charts.

• Minimize the fear of malpractice, which is driving many physicians out of practice, through tort reform.

Remember broad social lessons of the past. “Forced busing” to integrate schools proved counterproductive. Many parents sent their children to alternative private schools. Similarly “forced insurance” may result in more patients seeking out private alternatives and more doctors offering those alternatives , such as cash only practices, concierge practices, retail outlet or work site clinic care, and other alternative forms of care outside the bounds of government-sponsored care.

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