Clinics Here, Clinics There

A growing number of doctors in the UK support charging patients:

In Pulse’s survey, 51% of the 440 GPs who participated said yes when asked: “Would you support charging a small fee for all GP appointments?” Some 36% were against and 13% did not know. That 51% figure is a big rise on the 34% Pulse found when it posed the same question last September.

Dr Stephen McMinn, a pro-charges GP in Bangor, County Down, told Pulse: “[It] has been shown to work in other countries. There needs to be some pressure to decrease patient demand and expectation.”

The idea was shot down by the NHS. From this side of the pond, this doesn’t surprise me a whole lot. In conversations between doctors, I hear variations of things like “If they just had to pay $5/$20, they wouldn’t waste our time/resources.” (Note, I hear this from physicians I would describe as liberal, which is actually quite common in primary care and obstetrics.) Of course, the counterargument is that people won’t get the help they need, which will then snowball into worse and more expensive care down the line. In the aggregate, preventive care has not been shown to save money and may strain budgets, early detection can certainly have some benevolent results.

Meanwhile, in Montana, movement is in the other direction with a free clinic in Helena:

The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.

Even so, division manager Russ Hill says it’s actually costing the state $1,500,000 less for healthcare than before the clinic opened.

“Because there’s no markup, our cost per visit is lower than in a private fee-for-service environment,” Hill says.

Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.

I’ve actually been throwing this idea around in my head. Namely, that if the government (federal government being what I had in mind) ran its own clinics, it could dictate the rules in such a way to minimize the costs, as is happening in Montana. The government already runs free clinics in various capacities for select individuals. Could we expand that into a system for all people whose health care is provided by the government?

Dave Schuler is unusually optimistic. (Trust me, for Dave, “this experiment bears repeating” is optimistic.)

I would like to see this repeated and expanded, though I foresee a strong possibility of scalability problems. It’s one thing to staff a hospital in Helena, but it’s another to try to form a national network. I’m not sure how many physicians, even primary care ones, are eager to join the ranks of government with government pay. The government does staff these positions – more or less – but it would have a harder time trying to do so nationwide. (Disclaimer: My wife did some work for IHS. The bureaucracy was aggravating, but there was quite a bit to like there. A surprisingly positive environment. But we can’t afford the pay cut with student loans hanging over her head and a late start in savings.) (Also, note: This isn’t a government thing. Kaiser Permanente and Mayo have workable models, but they aren’t scalable.)

But! Maybe it can be made to work. Salaries can be raised or something else can be offered to physicians willing to work there. Perhaps an increased reliance and experimentation with mid-level providers. Or with a paucity of truly private-sector jobs, maybe some docs would pretty much have to get their starts in these sorts of clinics before they realistically could strike out on their own. It’s hard to say.

So, as Dave says, it’s worth experimenting with.