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Interesting video, John. There’s no problem with “physician-run” hospitals, we’ve had that for years with medical directors and physicians sitting on the boards. The problem begins with “physician owned hospitals” where the number and type of medical procedures and admissions pad the wealth of the physician.
I have great respect for physicians and believe they should be paid VERY well, but not on the basis of how many tests they order, surgeries they prescribe for themselves to perform, or patients they admit to the hospital they own.
The doctor—patient relationship is a joining of mutual trust between a doctor and a patient. If the doctor has a built in conflict of interest, then this relationship becomes disadvantaged, no matter how sincere and competent the doctor is. Doctors should not have ownership in hospitals, nursing homes, outpatient testing facilities, drug companies, etc., or investments in same. If they do not have ownership in these entities, then they can admit patients as necessary, order MRI exams as necessary, etc. etc.
The conflict of interest can actually become constraining for the doctor if he/she starts to question whether the test is being ordered because he/she will profit from the test. This conflict interferes with medical thinking. The only thing that should be on the doctor’s mind is, What is the best way to proceed for this individual patient?
Since demand is, in essence, unlimited, the way for America to afford unconflicted medical thinking, i.e., the doctor—patient relationship being the director of health care expenditure, is with a single payer that controls cost, price paid, for medical procedures, tests, office visits, hospitalizations, drugs, etc.
Regarding procedures performed by physicians and for which they receive a reasonable fee, there will always be the question of whether individual physicians are performing unnecessary procedures for the purpose of lining their own pockets as opposed to doing the procedure because it is the correct thing to do. I cannot make this question, this potential conflict of interest, go away. Placing physicians on a salary, i.e., making them employees of the government, would be a disaster, in my view. And requiring approval from some review board in advance of doing the procedure is fraught with danger because not only does the review board not see the patient but also because the people on the board operate with the dollar bill as the bottom line as opposed to good medicine. I think a reasonable fee for service, set by the single payer, must be viewed as not being a strong conflict of interest, especially in light of the fact that there is so much work to do. Then with ongoing reviews of individual physician’s work, (I have described a mechanism for this to occur in my book) physicians who are not doing the right thing would be discovered and dealt with. The starting place for health care solutions is with sound, ongoing doctor—patient relationships, with the optimism that we all once again start trusting our doctors, and with the mandate from our single payer that the doctors in America perform in a manner that deserves this trust or else.
I wholeheartedly agree, Doctor K. I think a reasonable fee-for-service arrangement is very workable, and sometimes an overpayment will simply offset things he doesn’t get paid for (like phone calls, discussions with colleagues, etc).
I would support some form of post review by an independent party. If a doctor is found to be over-ordering, he should be reprimanded. If the patient is found to be abusing the system, higher co-pays might resolve the problem. But nobody should step in to pre-approve tests.
Jack
re: “I would support some form of post review by an independent party. If a doctor is found to be over-ordering, he should be reprimanded.”
I agree but there are plenty of opportunities RIGHT NOW for some “muckraking Journalism” in this area with fraud and abuse by all parties involved.
(hint hint)
John
That’s a great video. And as a fan of “decentralization” and a supporter of the “free market” and “competition” who’s wary of “corporate consolidation” and “over regulation” I would definitely side with the Doctors and Physician run hospitals. Seems like another case of the “big guys” who can’t compete without a little help from their friends (in Congress) http://youtube.com/watch?v=EmOtWyjs8iU
All of you overlook the main point of this video—politicians pandering to one interest group over another with the end result being politicians deciding against the evidence presented that physician run hospitals have better patient outcomes in favor of the bigger and louder hospital lobby. You want single-payer government health care–this is how decisions will be made. Politicians will pick and choose who and what they will support in healthcare despite scientific evidence to the contrary. These are people without medical backgrounds who will determine the winners and losers based upon the efforts of lobbyists and special interests. The health care consumer will be the loser.
Where in the world does it say that physician-run hospitals have better outcomes? It has been shown that for-profit hospitals and HMOs have worse outcomes than non-profits, and physician-run hospitals turn down the uninsured an unprofitable patients! http://www.pnhp.org
It says in the video, that studies of physician run hospitals show less hospital acquired infections, better outcomes and are less likely to die as compared to “big-box” hospitals.
I don’t know what it is based upon, but, assuming its true, the video explicitly demonstrates how health care decisions decided by politicians are not necessarily in the best interest of patients.
But, if you are basing your defense on “research” from Physicians for a National Health Plan, this is an agenda driven organization whose “research” is conducted by a handful of researchers affiliated with the blue-bloods from Harvard and the Canadian Medical Association. Half of the articles listed in their research are based upon outdated information (honestly–1987??????), several based conclusions on a “meta-analysis” of available data (always suspect) and are using “research” to support an agenda instead of researching to gain clarity and objectivity in understanding the problems with out health care system.
I would tend to side with Doctors over bureaucrats when it comes to “more bang for the buck” in “health care”. Too many bureaucrats = “staff infection”. There are always going to be people wringing their hands over the problems with health care. I don’t want to say IGNORE them but it might not be a bad idea.
Damn, then I guess we have to believe the video, huh?
That was made by a special interest group that is funded by “physician owned” hospitals. By law all others have physicians running them.
You’d have to be pretty dense (or part of the industry) not to see what that video is up to.
Besides, physicians are terrible managers, and having a financial interest in the hospital makes them worse, not better.
But so be it. You take your family there if you wish. And once again, Bill, I am treated by my doctor, not bureaucrats. If you have an agenda and need to keep saying that, fine. But it is untrue.
December 9th, 2007 at 10:06 am
Interesting video, John. There’s no problem with “physician-run” hospitals, we’ve had that for years with medical directors and physicians sitting on the boards. The problem begins with “physician owned hospitals” where the number and type of medical procedures and admissions pad the wealth of the physician.
I have great respect for physicians and believe they should be paid VERY well, but not on the basis of how many tests they order, surgeries they prescribe for themselves to perform, or patients they admit to the hospital they own.
December 9th, 2007 at 12:13 pm
The doctor—patient relationship is a joining of mutual trust between a doctor and a patient. If the doctor has a built in conflict of interest, then this relationship becomes disadvantaged, no matter how sincere and competent the doctor is. Doctors should not have ownership in hospitals, nursing homes, outpatient testing facilities, drug companies, etc., or investments in same. If they do not have ownership in these entities, then they can admit patients as necessary, order MRI exams as necessary, etc. etc.
The conflict of interest can actually become constraining for the doctor if he/she starts to question whether the test is being ordered because he/she will profit from the test. This conflict interferes with medical thinking. The only thing that should be on the doctor’s mind is, What is the best way to proceed for this individual patient?
Since demand is, in essence, unlimited, the way for America to afford unconflicted medical thinking, i.e., the doctor—patient relationship being the director of health care expenditure, is with a single payer that controls cost, price paid, for medical procedures, tests, office visits, hospitalizations, drugs, etc.
Regarding procedures performed by physicians and for which they receive a reasonable fee, there will always be the question of whether individual physicians are performing unnecessary procedures for the purpose of lining their own pockets as opposed to doing the procedure because it is the correct thing to do. I cannot make this question, this potential conflict of interest, go away. Placing physicians on a salary, i.e., making them employees of the government, would be a disaster, in my view. And requiring approval from some review board in advance of doing the procedure is fraught with danger because not only does the review board not see the patient but also because the people on the board operate with the dollar bill as the bottom line as opposed to good medicine. I think a reasonable fee for service, set by the single payer, must be viewed as not being a strong conflict of interest, especially in light of the fact that there is so much work to do. Then with ongoing reviews of individual physician’s work, (I have described a mechanism for this to occur in my book) physicians who are not doing the right thing would be discovered and dealt with. The starting place for health care solutions is with sound, ongoing doctor—patient relationships, with the optimism that we all once again start trusting our doctors, and with the mandate from our single payer that the doctors in America perform in a manner that deserves this trust or else.
R. Garth Kirkwood M.D.
http://www.equalhealthcareforall.com
doctork@equalhealthcareforall.com
December 9th, 2007 at 1:16 pm
I wholeheartedly agree, Doctor K. I think a reasonable fee-for-service arrangement is very workable, and sometimes an overpayment will simply offset things he doesn’t get paid for (like phone calls, discussions with colleagues, etc).
I would support some form of post review by an independent party. If a doctor is found to be over-ordering, he should be reprimanded. If the patient is found to be abusing the system, higher co-pays might resolve the problem. But nobody should step in to pre-approve tests.
December 9th, 2007 at 3:17 pm
Jack
I am gald you like it !
December 10th, 2007 at 7:03 am
Jack
re: “I would support some form of post review by an independent party. If a doctor is found to be over-ordering, he should be reprimanded.”
I agree but there are plenty of opportunities RIGHT NOW for some “muckraking Journalism” in this area with fraud and abuse by all parties involved.
(hint hint)
December 10th, 2007 at 7:10 am
John
That’s a great video. And as a fan of “decentralization” and a supporter of the “free market” and “competition” who’s wary of “corporate consolidation” and “over regulation” I would definitely side with the Doctors and Physician run hospitals. Seems like another case of the “big guys” who can’t compete without a little help from their friends (in Congress)
http://youtube.com/watch?v=EmOtWyjs8iU
December 10th, 2007 at 7:18 am
Bill
Great Video!
December 10th, 2007 at 2:34 pm
All of you overlook the main point of this video—politicians pandering to one interest group over another with the end result being politicians deciding against the evidence presented that physician run hospitals have better patient outcomes in favor of the bigger and louder hospital lobby. You want single-payer government health care–this is how decisions will be made. Politicians will pick and choose who and what they will support in healthcare despite scientific evidence to the contrary. These are people without medical backgrounds who will determine the winners and losers based upon the efforts of lobbyists and special interests. The health care consumer will be the loser.
December 10th, 2007 at 7:41 pm
Where in the world does it say that physician-run hospitals have better outcomes? It has been shown that for-profit hospitals and HMOs have worse outcomes than non-profits, and physician-run hospitals turn down the uninsured an unprofitable patients! http://www.pnhp.org
December 10th, 2007 at 8:32 pm
It says in the video, that studies of physician run hospitals show less hospital acquired infections, better outcomes and are less likely to die as compared to “big-box” hospitals.
I don’t know what it is based upon, but, assuming its true, the video explicitly demonstrates how health care decisions decided by politicians are not necessarily in the best interest of patients.
But, if you are basing your defense on “research” from Physicians for a National Health Plan, this is an agenda driven organization whose “research” is conducted by a handful of researchers affiliated with the blue-bloods from Harvard and the Canadian Medical Association. Half of the articles listed in their research are based upon outdated information (honestly–1987??????), several based conclusions on a “meta-analysis” of available data (always suspect) and are using “research” to support an agenda instead of researching to gain clarity and objectivity in understanding the problems with out health care system.
December 11th, 2007 at 12:16 am
I would tend to side with Doctors over bureaucrats when it comes to “more bang for the buck” in “health care”. Too many bureaucrats = “staff infection”. There are always going to be people wringing their hands over the problems with health care. I don’t want to say IGNORE them but it might not be a bad idea.
December 11th, 2007 at 12:32 am
Damn, then I guess we have to believe the video, huh?
That was made by a special interest group that is funded by “physician owned” hospitals. By law all others have physicians running them.
You’d have to be pretty dense (or part of the industry) not to see what that video is up to.
Besides, physicians are terrible managers, and having a financial interest in the hospital makes them worse, not better.
But so be it. You take your family there if you wish. And once again, Bill, I am treated by my doctor, not bureaucrats. If you have an agenda and need to keep saying that, fine. But it is untrue.