In a previous post, I wrote about the benefits of the medical home, a community-based model that uses a variety of technologies to support the medical needs of its patients. In that post, I suggested that the medical home model could be used to provide care to patients whose insurance coverage would not otherwise cover it. A recent study by the University of Wisconsin found that patients receiving inpatient care on the UW Health System's Health Care Connector were more likely to experience better care than those receiving care in the community. However, while the research on the UW Health Connector is still pending, it raises the question of what other models could be used to provide inpatient care at the community level. There clotrimazole two basic approaches to providing care through the Community Health Access Network, a system of managed care entities and the Community Health Insurance Network, a system of community-based insurance companies that provide coverage for a small percentage of the population. MCEs are private companies established to provide care in an unlicensed environment and MCI is a combination of MCEs and community based insurance. In a previous piece, I argued that the Community Health Care Institute is the most logical model for providing health care in the community.
However, the CHCI model has also been criticized by critics as being too costly, with too many barriers to coverage, and not providing enough care to patients. CHCI also has significant limitations, for example, the cost of the network per hospital visit may not accurately reflect the cost of care. In addition, even though CHCI provides a network of services, there have been numerous complaints that the quality of care is significantly lower than if there were a more comprehensive system. A better alternative would be to move towards a community health system as is being done by the California Department of Insurance. This lack of accountability meant that physicians were often the most likely to overspend, resulting in an even greater risk that the insurance premium would eventually spike. The problem started when doctors in private plans were pressured to cut costs to avoid increased insurance premiums and to maintain or attract patients. The result was that many doctors began to overuse the services rendered to them by their patients, leading to the doctor shopping problem. The doctor shopping problem is one symptom of the greater problem of the erosion of medical independence.
In many parts of the country, it is now nearly impossible for a physician to practice medicine without being dependent on an insurance company. Many doctors are unable to afford the high out-of-pocket costs of private insurance, even if they are not poor, and may end up being in financial straits due to their inability to pay for their own health care costs. The end result is that a lot of physicians become trapped in the same old ways of doing medicine and have difficulty practicing independently. The result is that a lot of physicians become very complacent and lose touch with real patient needs, resulting in poor care, unqualified physicians, and high rates of patient failure and mortality. What can be done to help this problem? A number of different proposals have been put forth by physicians who want physicians to be independent, including setting fees that do not encourage excessive use of services, increasing transparency by encouraging physician-specific pay scales, allowing physicians to practice without an insurance company, and allowing physicians to continue to practice independently if they choose. Many of these plans and measures are good ideas, but there are many problems with them.
One of the problems we face is that in our fragmented and fragmented economy, there are many ways of doing business in a number of different countries. We have so many competing interests, so many competing interests within the medical profession, that it is difficult to create a coherent solution to the problem. The only way that the medical profession can address this problem is by working to resolve the problem of physician independence.
It is the responsibility of the professional organization representing physicians to come up with a collective plan that is truly sustainable over the long term. I will not discuss in detail the ideas that have been put forth by physicians who want to be independent, nor do I think they are very realistic. However, I will discuss what I believe is a feasible approach that can work across a variety of settings. It is my hope that this discussion will be enlightening and will stimulate some discussion among physicians and medical administrators.