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BLOG: The commoditization of health care
Health care “reform” has brought about some positive, some interesting and some very challenging circumstances for doctors practicing medicine.
I have written previously about how the world is beginning to treat doctors as it did pilots a generation ago. But more than just treating us like hourly employees, health care reform is pushing doctors into a role like a returns desk clerk at Costco.
Here are four factors that are driving this disturbing change:
1. Many patients don’t understand the economics of their own insurance plan. As health insurance premiums rise, patients are shifting more and more into high deductible plans. Clearly, patients win if they don’t need to have care, but when patients do need to see doctors, they can be shocked to be responsible for the entire cost (albeit contracted rate) of their treatment. To them, it seems like little consolation that they signed up for a deductible of several thousand dollars toward medical services, diagnostics, surgery, facility fees and anesthesia fees. It’s natural for them to blame the one presenting them the bill. A lab or facility is faceless, but with their doctor they have a personal relationship — one that is newly becoming strained by this dynamic.
2. By and large, patients don’t shop around for doctors based on pricing, and price shopping would hardly make a difference when their insurance contract would call for very similar rates among all doctors. This probably needs to change, with insurance companies being required to tell patients not just the cost of a monthly premium but the health plan’s average out-of-pocket cost paid by the average patient with the average health history.
3. High out-of-pocket costs are blurring the lines between basic and premium services. “Covered” used to mean “paid for,” but now patients who have the least ability to pay, that is, those who choose high deductible plans, must pay the cost of the basic “covered” services in cataract surgery. A few years ago, these same patients might have been able to stretch to afford add-on services like laser astigmatism correction or a premium lens implant. Not any longer. It’s somewhat understandable for them to feel that they’ve paid a premium price for surgery and, therefore, deserve to see without glasses, even if they opted out of these add-on extras.
4. Patients have been trained by the retail world that if they’re not satisfied, they’re not paying. Most who are not experienced in health care don’t understand that doctors are paid to provide a service rather than an outcome. Facing high out-of-pocket costs, they might mistakenly feel that a doctor is financially responsible when a patient doesn’t react to a procedure in the expected way. No matter their risk status, some can feel that only a perfect result deserves payment.
In response to this, many physicians now have found it necessary to collect any fees that are the patient’s responsibility before surgery rather than after. Moreover, patients feel justified in asking for a refund, or further surgery at no cost, if they are not pleased with their results.
All this is happening while reimbursement to physicians for the same services is declining over time, and the cost of employing our staffs and maintaining our offices continues to rise.
How do we address this collision of interests? There’s no simple answer, but educating our patients gently about the realities of health care costs before those costs are incurred will go a long way toward avoiding misunderstanding.
With time, I believe the health care system will make more transparent the possible costs to patients of choosing different health care plans, and people will begin to understand that practicing medicine is not the same as selling flat screen TVs. Meanwhile, treating each patient as a friend and doing our level best to help them understand the health care system we work in may be the best that we can do.