Wednesday, April 09, 2008

A Shortage of Primary Care Physicians?

A recent piece in the NYTimes discusses Massachusetts' experience after enacting its health insurance reforms which mandated coverage for all its citizens. The article discusses how the structure of reimbursements has shifted how many people enter into primary care. It's little surprise that this is the outcome, given situations like this:

Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.

“I calculated that every time I have a Medicare patient it’s like handing them a $20 bill when they leave,” she said. “I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?”

I imagine some politicians out there believe that the "magic of the market" can solve this problem. To a certain degree, as the supply of PCPs shrinks, salaries should rise, but given the way the private health insurance system works, this "market correction" does not seem likely. Doctors are too weak in the system, and the insurance companies end up looting both them and their patients. Think about it: the insurance company not only sets the "price" (the premium / deductible) for the patient, but also for the physicians (in terms of reimbursement rates). Why should this be the case? Can you imagine if your auto insurance company charged you to let you buy a car and then decided how much to pay the car dealership when you went to get that car? It's just ridiculous.




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