Wednesday, May 7, 2008

Primary care doctors - Health Care Fundamental

Life is short, but health care debates are long. During debates, there are highs and lows – suggestions for rebuilding the system from the ground up, innovations to better the system, reports and retorts for reform.

But underlying the sound and fury, one fundamental never changes: doctors are at the center of the system. Only doctors can “practice medicine,” and most patients like it that way.

When push comes to shove, people go to doctors for relief of symptoms and pain, to find what’s wrong, and for an expert opinion based on education and experience. Most people trust doctors, they know doctors have gone through an arduous educational process, they’re aware the system, for the most part, allows only
physicians to prescribe medications and to perform procedures.

And they know, in their heart of hearts, and in their left and right brains, that hospitals would not exist without doctors, that doctors are more to be trusted than health plans, and that other approaches to care by American doctors - whether by alternative practitioners, nurse practitioners, nurse doctors, physician assistants, or Internet advisors – have value but in the end, doctors are best suited to care for the sick. This is not to denigrate other approaches, but to note, for the most part, the American physicians will continue to care for most of the people, most of the time, in sickness and in health.

I was thinking of this physician-centered undamental when recently reading about the state of retail clinics and medical tourism.

• Retail clinics have grown from 125 to 963 in the last three years. That’s impressive, and they are projected to grow even further. Walgreens says it will open 240 more by the end of the year, and Walmarts plans to open 400 more under hospital sponsorship. But the bloom may be often the retail rose. 69 clinics have closed this year in 15 states, due in part to startup expenses $500.000 secondary to marketing, complexity of operation, and the 18 to 24 months needed to break even. Those are the tangibles but there are intangibles too – patients leery of places that don’t have “real” doctors, absence of a traditional medical environment, fear of malpractice, failure to cure or dissatisfaction with results, and the fact that some end up in doctors offices for a definitive opinion or treatment.

• Medical tourism has gained a lot of cachet in last five years because of the globalization movement. It’s been widely noted that wealthy foreigners flock to the U.S. for care at such places as Mayo, the Cleveland Clinic, and Hopkins, and that Canadians and other ration-refugees from nationalized systems, jump the waiting lines to come to the U.S., and that the U.S. uninsured or underinsured reverse traditional migration patterns by traveling to India, Hong Kong, Thailand, and Singapore for cost relief. According to a report by MacKensey estimated 60.000 to 85,000 went abroad for care, where 710.000 procedures were performed. The fundamental here is that these numbers represent a ripple not a wave, and that the fundamentals – fear of the unknown, legal problems, and lack of follow-up, will slow the growth of medical tourism.

Sometimes, it helps to be reminded of the basics.

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