Getting Appointments For Transitions

By Author: Marcus Stalder
Total Articles: 491
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No matter who you are and how well insured you and your family, there are increasing problems in getting access to health care. The main reason is the falling number of doctors opting to join the ranks of the frontline troops in general practice. Not only is the image of a surgeon in a large hospital more attractive, the financial rewards are also substantially better. Put the two together and the best in each new group of doctors vote with their feet. Many rural areas now lack adequate cover. Gone are the days when good ol' doc would negotiate to take a chicken in return for delivering a baby. Now few want the life of a country doctor where they are on call round the clock and may have long distances to travel between house calls. The financial rewards are poor and for-profit doctors are not willing to accept chickens and the respect of the community as adequate substitutes. It's the same in the more run-down urban areas where the few who do set up a practice find themselves routinely snowed under by communities without access to adequate care.

Since the majority of health plans depend on the ready availability of primary ...
... care physicians to act as gatekeepers to the rest of the healthcare services, this is creating an unfortunate bottleneck. Even though you may have a serious medical problem, you may have to wait weeks before you can see your designated doctor. Now let's turn the problem on its head. Suppose you have a medical emergency that takes you into an ER room. You break your leg. As a routine part of the treatment, the doctors take your blood pressure and find it unusually high. They warn you to have follow-up treatment to avoid this developing into more dangerous territory where you might have a heart attack. This is a transition situation where the hospital refers you back down the system. As it stands, you do not qualify as an emergency. You have to come back up through the system.

A recent survey published in the New England Journal of Medicine reports on the scale of the problem. If you have no insurance and limited cash, you face the longest wait. If you have Medicaid, you are also going to wait. The reason is simple. The private insurance companies pay higher fees for appointments. This gives the for-profit doctors a direct incentive to prefer seeing the privately insured. How do we "know" this is happening? The answer comes from secret shoppers, i.e. teams of researchers who telephone doctors to ask for appointments. When the US Department of Health proposed to use this approach, there was a mass protest by the medical profession. They objected to the element of deception (and the fact it disclosed abusive scheduling by the doctors). The Department of Health abandoned the idea.

When access to healthcare is increasingly difficult, it's extraordinary there should be no good quality information about whether the private health insurance companies are buying priority for their insured. If this was proved, those administering the public health insurance services could take action to balance access. As it is, patients are being victimized when they cannot transition from ER Departments to primary care physicians.