Capitation.
I know it sounds like a horrible term, and it is, but not in the way it sounds. Capitation is mentioned numerous times in HR3200, the current and only published bill on healthcare reform. It is mentioned on page 125, 333, 451, 452, and 778 as one scenario that they will be exploring to drive down costs.
Capitation is where each doctor has a certain number of patients, given out in a number of ways, either by geographic area, patient preference, whatever. The doctor is paid based on how many patients he has. Not how many he sees, but how many he has.
See any problem with that?
Sound familiar to anyone?
This is a very similar program to the way that HMOs use to operate. Doctors are not rewarded by how many patients they actually help, in fact the fewer they help the more attention they can give them and quite frankly the less stressful it is. The rest of the patients are simply told to wait. Doctors are encouraged to handle the patient issues as much as possible on their own; if they refer a patient out to a specialist then the normal payment that they receive is actually reduced; repeating a lot of the issues that made HMOs so infamous.
Some refer to this as the “Walmart” method of healthcare. Not only do the doctors not have any incentive to actually see patients but the more patients that they see the more money it will cost them and hence LESS money that they receive. That means there is actually an INCENTIVE for them to see fewer patients, perform fewer tests, less lab work, and refer patients to specialists less often.
That doesn’t mean that doctors are suddenly going to turn into these money hungry people that deny patients healthcare, but they would basically be punished for doing a better job and rewarded for being lazy. That’s a recipe for horrible healthcare.
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2 comments:
This is what I struggle with when I hear you talking...We have an HMO for Mike and I. It is very expensive, we get horrible care, our doctors are ridiculous and it just basically stinks. But it is the most that can be afforded. We also pay for a state run insurance, for the kids. It is awesome. Their doctors care. When there is a problem they send them to some one who takes care of them. They run tests when needed, and have always received excellent care. I am not saying the health care reform bill is good. I will be honest, I don't know, and from the little I've read about it I think it has some major problems. But our current health care system, for people who aren't rich, bites. If you don't have a company that can pay your insurance premiums what do you do???? What is your solution? Maybe you should consider letting go of your cushy company paid insurance and try paying for it on your own, and then lets talk about health care reform. I know that Mike worked for a big company I felt similar. When I got thrown into the world of "no insurance", and "your on your own insurance", I quickly realized how messed up the real world is. What do we do???
First of all, thanks for reading, I appreciate it.
Second, I understand that the current system works best for those who have jobs that cover insurance. It doesn't have to be that way and we don't need the government to come in and take it over to fix it. The system works good now for most of the people. We just need to fix it so that it works good for everyone. There are changes that we can make to do that. Reasonable changes. Easy changes. Changes that get government further OUT of the system. But I can't explain in a comment.
And until changes are made, you guys have obviously researched what's available in your area and are doing what you can afford and what... sort of works for you guys. Having everyone go on to the government option would actually make your situation worse. Imagine gobs more people trying to get appointments with the same people doctors that you have.
My next post I will detail what they need to do to make healthcare a reasonable expense for everyone.
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