Health Care Access
I continue to be disappointed by the incompleteness of the discussion of issues in the national health care debate. There is abundant discussion of coverage and affordability, considerably less coverage of preventive and wellness, almost no discussion of what is needed to assure adherence to required treatment programs for chronic diseases, and little discussion of the issue of access gaps.
Everyone associates unnecessary emergency room visits with lack of insurance coverage. Certainly, many people in emergency rooms are individuals lacking insurance coverage. However, there are many people who have relatively minor illnesses or injuries, but who go to emergency rooms because they incur their medical condition after their primary physician’s office closes for the day or on a Sunday, when their physician’s office is most likely closed.
The first question we need to ask is why physicians have office hours comparable to the hours of business for American retailers over 40 years ago. The main reason is that the majority of medical practices are either sole practitioner or small groups, with little ability to provide Sunday or late evening coverage.
Beyond that, there simply are many areas that do not have what we have in Stamford, Connecticut, an urgent care center that is open seven days a week, the Tully Center, which is part of the Stamford Health System. I have been in communities as diverse as downtown Chicago, downtown Los Angeles, and King of Prussia, Pennsylvania, that have had no non-hospital-based urgent care facilities for minor illnesses and injuries.
To some degree, the problem is the economics of urgent care in some states, with shortages of physicians, nurse practitioners, and nurses that could staff such facilities. In addition, with such a complex issue as health care, state and local government officials may not be able to focus on the specific problem of after-hours care, nor propose the solutions that could mean higher quality care at a lower cost, which most well run urgent care centers provide. The primary care physicians may also not favor having to address patient issues that may arise from another provider.
At Pitney Bowes, we have effectively operated an urgent care clinic inside many of our facilities. Our clinics treat minor illnesses and injuries to avoid the problem of employees leaving the office for several hours to go to an outside appointment. We also do preventive screenings and immunizations, and we help refer employees to specialists, with the cooperation of their primary care physicians. We work closely with the primary care physicians in the community to make sure we provide a complementary service, not a competitive one.
We also provide space inside our facilities for specialists who have many employees as patients, and enable them to see many patients in a more focused and shorter period of time than they would in their offices.
There are other access gaps in the health care system, such as the shortage of home health nurses and geriatricians, or the emerging shortage of primary care physicians in some communities.
I do not see how we can attack cost-related issues associated with coverage unless we also come to grips with these access gaps.
September 17th, 2007 at 2:37 pm
Hello Mike:
I would like to start of by showing my appreciation to an excellent “urgent care clinic” we have at our PB Shelton campus, thanks again!
Something I like to add in regards to physicians doing it right the first time would make the matters of healthcare cost becoming more rational to the consumer for example.
When a patient visits his primary doctor, say for a hip problem, his/her doctor refers a specialist. Next, the patient calls and schedules an appointment with the specialist; the patient is required to make an office visit. By the time the patient sees their specialist, the doctor asks them a couple questions (no examinations) and tells them that they need an X-ray or MRI (conditions apply) and has their receptionist schedule an appointment at the hospital. Time wasted! Yes! The patient has to take time off of work and usually has to wait (inside the waiting room) pass their scheduled time of visit in addition, wait again inside the examination room, just to see they doctor for 3-5 minutes. Lastly, a bill sent to the patient’s healthcare provider for an unproductive office visit (IMO). This is just one example as in why high health care costs are unjustified.
In closing, I do believe that the lawyers contribute to the dilemma that is, they have the upper hand when it comes to cost (i.e. Malpractice suites, etc) however. I will not venture into those waters.
Thanks,
~PM
October 1st, 2007 at 4:39 pm
Hi Mike. I just visited the blog for the first time today. My only comment is that the concept of ‘mandatory coverage’ and ‘competition’ are incompatible. Not to mention, ‘mandatory coverage’ sounds like ’socialism’ to me, and I prefer to believe we can again live in a free country.
I agree about some of the other points you made about farm subsidies.
I believe that Americans are caring and creative enough to make the issue much less of one for government intervention and still have excellent care where it’s needed.
(I’m also a supporter of Ron Paul for President - the only MD on the ticket!) -cmw
October 4th, 2007 at 11:13 am
Dear Mike:
As you know, navigating the raidly changing enviorment at the national, state, and local levels is difficult. There is a non-profit in Washington, D.C. “eHealth Initiative” created for just this purpose. eHI engages every stakeholder involved in healthcare-both nationally and locally - to find common ground and drive the implementation of principles, strategies and best practices for using information and information technology to improve healthcare for patients. The leaders of eHI represent nationally reconized experts and leaders from accross every sector of healhcare. As you may know, eHI represents a broad range of constituencies, including but not limited to clinicians, consumer groups, employers, IT suppliers, health plans, hospitals, pharmaceutical and medical device manufacturers, pharmacies, public health agencies, quality improvement organizations, and state and regional collaborative organizations. And, as you know, cohesion and a shared vision across these diverse perspectives does not happen by itself.
At eHI, they are finding common ground on a set of principles, strategies and actions for mobilizing clinical information electronically that is responsible, sustainable, trustworthy, and meets the needs of every stakeholder in healthcare–most importantly patients. And they have created a special place where there is mutual respect for differences and spirited dialogue directed towards consensus on an incremental, common path forward that works for everyone.
eHI is developing a Blueprint for Change, to be released to the public in October 2007, which represents multi-stakeholder consensus on a shared vision, principles, and policies for improving health and healthcare through information and IT. eHI is effectively influencing public policy to drive changes at the national, state and local levels. Their working groups provide opportunities to interact with congressional staff, top agency officials and staff, as well as private sector leaders such as yourself. Give them a look!
http://www.ehealthinitiative.org