Monday, April 20, 2009

When Doctors Opt Out

We already know what government-run health care looks like

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

The dropout rate is less at major medical centers such as New York University's Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.

Overall, 11% of the doctors at NYU Langone don't participate in at least two insurance plans -- Aetna or Blue Cross, for instance -- so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.

Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

I wouldn't want to be a patient when that happens.


NHS maternity units will still be short-staffed despite surge in number of midwives

NHS maternity units will still be seriously short staffed even after a surge in the number of midwives promised by the Government, critics claimed today.

More than 3,000 extra midwives will be in place by 2012 but new research has found they will still be delivering more babies per year than stipulated by safety guidelines - putting mothers and babies at risk.

The number of births each midwife handles has been rising relentlessly for six years, and is now higher than at any time since Labour took office in 1997.

Ministers' failure to anticipate a rising birth rate by employing enough midwives has led to a doubling in the number of payouts for medical blunders, and for the fact that rising numbers of women are being left alone and terrified during labour.

Experts believe up to 1,000 babies a year die needlessly because doctors and midwives are too overstretched or poorly trained to detect warning signs.

Safety guidelines, laid down by the Royal College of Midwives, say that midwives should deliver an average of 27.5 babies a year - one every 13 days or so - to ensure mother and child have the best quality of care.

In January, the Daily Mail revealed that the average midwife was delivering 34 babies a year, or one ever 10 or 11 days - almost 25 per cent more than they should under the safety standard.

Ministers have promised an extra 3,400 midwives by 2012 to plug the shortage. But new research by the RCM says this means that only four of the country's 10 health regions will meet the safety standards.

Of the six that will fail, four will have more than 32 births per midwife. The East of England region will have a massive 35.2 births per midwife in 2012, followed by the East Midlands (33.9), Yorkshire and the Humber (33.8), and London (33.6).

The Yorkshire figure is actually worse than the current ratio, largely the result of projected birth rate rises, which are largely down to the impact of immigration.

Critics also claim much of the money ministers are earmarking for maternity services is not reaching wards and is being spent on other parts of the NHS.

They say the figures prove the Government has no chance of honouring its pledge that all women should have one-to-one care from a named midwife during the entire pregnancy by the end of this year.

Cathy Warwick, general secretary of the Royal College of Midwives, said: 'Although the situation for most regions will be better, it will still not be good enough to deliver the quality of care women need.

'A step change is needed at regional level to recruit more midwives, and we hope that decision makers will treat it as a priority and put money they have been given for maternity services into maternity services.'

Conservative health spokeswoman Anne Milton said: 'Midwives' morale is currently low and too much of their time is wasted by bureaucracy and red tape. We need to ensure that the workforce spends more time delivering healthy babies from healthy mothers than filling in needless forms.'


Australia. A "caring" Leftist health minister says that the red tape comes first: So you must die

The "caring" one above

A SYDNEY woman who has been told she has six months to live will try to raise more than $2 million for life-saving surgery in the United States after her plea for government funding was rejected. Pauline Talty, 36, from Kellyville, was told on Thursday she would not receive money to have a small bowel transplant in Pittsburgh, under the Federal Government's Medical Treatment Overseas Program, because the operation could be performed at an Australian hospital. Specialists at Melbourne's Austin Hospital, while trained in the procedure, have never performed a bowel transplant because of a lack of donor bowels.

Ms Talty has short bowel syndrome, which developed after her intestines were damaged from radiotherapy she received for treatment of childhood cancer of the kidney.

She said having the operation in Melbourne would put her at "risk of serious complication or even death". "My case is very complex and I don't want to be their first one. I only get one shot at this and if the Austin messes it up, I die. I don't get a second chance."

Due to Ms Talty's stunted bowel growth from radiotherapy, she needs a child's bowel, but Professor Bob Jones, head of the Austin's liver transplant program, told her she may have to wait years for a donor. The average wait for a child's bowel in the US is 240 days. "I don't have years. I was told in October that I have 12 months to live and I have just wasted five months trying to appeal the Government's decision.

"In Pittsburgh, they have been doing this for 20 years and have a 96 per cent success rate, which they have only achieved in the past few years. They have an abundance of bowels so I am not giving up."

The federal Health Minister, Nicola Roxon, said: "I have real admiration for Pauline Talty, for her courage, and determination and I know this must be an incredibly difficult time for her. [But] there are clear, established guidelines for assessing applications under this program … which all applicants must meet."

Ms Talty, who was a business strategist before she became ill, has been in Royal North Shore and Royal Prince Alfred hospitals for 13 months. She is fed through tubes in her chest and groin. Ms Talty has already raised about $200,000 for her living expenses and nursing care while in the US but is now appealing to the public for money to pay for the bowel surgery.


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