Reforming healthcare

I've come up with a way to completely reform healthcare and make it more affordable and more effective. It won't happen, because doctors and insurance companies would hate it.

I am going to be talking about old-fashioned general practitioners here, mostly family/general practice and internists. These are the kinds of doctors that most of us use as 'our' doctors.

Each doctor would be assigned a certain number of patients in certain age groups. 25% would be 18-35, mostly young and fairly healthy. 50% would be 35-60, middle-aged with some problems. 25% would be 61+, some with more problems than others. For sake of argument (and smaller numbers) lets give this doctor (let's call him Dr Paul) 150/150/50 patients from each group.

Furthermore, these patients pay Dr Paul every month for their healthcare. First group pays $25 a month, next group $50, and the last group $75. This makes Dr Paul about 15,000 per month or 180K a year. Not a bad pay rate huh?

Ah, but there is a catch, a huge one. Dr Paul gets paid only as long as a patient is healthy. I'll explain more as I go on.

Let's say you are a 30 year old man, about 20 pounds overweight. You don't smoke, but you drink every weekend and you don't exercise much at all. You come in not feeling well and Dr Paul finds that you have marginally high blood pressure. Now today, the doctor might tell you to lose some weight and write you a prescription for high blood pressure meds. Now though, the doctor doesn't want you to just take meds. Because meds are paid for by the doctor. After all, you're sick and he's not healing you!

So, Dr Paul is very much into prevention. He will talk to you about diet, about exercise. He will refer you to a dietician and a fitness trainer. Since these are people he would need a lot, he would have set up either individually or through a physician's organization (like a businessman's organization) to have set referral fees to people like this. This sort of payment for referrals would apply to all types of specialists, from physical therapists, massage therapy, acupuncture, chiropractic, surgeons, and other specialists.

Now this may sound strange, but think about it from a fair market point of view. If you are a surgeon, you are not going to get any patients (mostly) except by referrals. And if you charge too much, you aren't going to get many referrals and therefore, not make a lot of money. And if you are Dr Paul, you want someone who will do a good job, but also not charge you too much.

That's the problem today. Doctors don't worry much about how much things cost, or even how much it costs their patients. That is unlike any other type of business, where cost control and efficiency is very important.

Continuing our example, if you do need blood pressure medication, Dr Paul won't just automatically give you the latest, greatest (and most expensive) medication. There are a lot of slightly older medications, with less side effects and yet still are about 80-90% as effective as newer drugs. And cheaper. Again, the doctor would have an agreement with a pharmacy for them to buy in bulk and pass on the savings to the doctor.

Remember, it is now in the doctor's best interests to keep you healthy. So Dr Paul will have to follow up with you, see how the diet is working. encourage you to work out. It won't just be handing out a copy of a diet, a prescription and 'see me in 3 months'. There have been some experiments with many caregivers doing ongoing followup and the patient's outcomes are much, much better.

Now, to followup about getting paid while the patient is healthy. If you do come in with something short term, like a cold or blister, or broken finger, the doctor will take care of it and you keep paying your regular rate. But to take our example patient, the first month after his complaint and diagnosis of high blood pressure, the payment remains the same. Then the payment goes down, if the complaint continues.

2 months - 90% of payment
3-4 months 80% of payment
5-6 months 70% of payment
7-9 months 50% of payment
10-12 months 35% of payment
13+ months 20% of payment

There would be much more detail than this of course. But I think you can get the general outline from this.

Barbara