by iposse » Tue Oct 24, 2006 3:57 pm
[quote][i]Originally posted by XXX[/i]
<br><p align="justify">Finding a good/honest doctor is like finding a good/honest mechanic. If you have state-funded medi-cal, they're more than happy to order the whole enchilada of tests and visits to bilk the system. If it's an HMO, then, yes, they have to engage in cost-cutting - even for stuff that is or might be necessary[xx(] Buncha crooks, really.
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Well, Medi-Cal has historically paid extremely low reimbursement rates to doctors. The only way to "bilk the system" is to bill for tests and visits that aren't actually performed. To prevent this, the state of California will occasionally send auditors down to doctor's offices/hospitals to thumb through all the patient medical records and make sure they're consistent with what was actually being billed to Medi-Cal. Doctors can get in a whole heap of trouble if the auditors find that things aren't right.
If the doctors belong to an HMO, the HMO pays the doctor a certain amount (a "capitation") for each patient that they see. It doesn't matter how long they see the patient, how many tests they run, etc. Thus, to echo NuWaveRx's comment, the more attention HMO doctors give their patients, the less money those doctors make. The overwhelming majority of doctors want to do a good job--but they're penalized for doing so.
Most doctors would like a system where patients simply pay for whatever services they have. The problem is, there are social "equality" issues (the very rich getting the very best services with the poor being shut out of their "right" to healthcare needs). Also, many doctors join HMO's because they wouldn't know how to get any patients otherwise (doctors aren't exactly business or marketing experts after all). The moral is that healthcare is thorny, and there's really no magic solution (although we do know that illegal immigrants are making it much much worse).