"If your doctor's office treated you like the fine customer you are, would you be willing to pay for that service? You might choose to do business with another professional based on an excellent level of service (accountant, designer, architect...), but chances are that you're paying directly to receive those services.
My staff and I do our best to stay on schedule, anticipate your needs, accomodate your requests...and I wish my small business could expect to be paid on delivery. But alas, there's the godforsaken rigamarole called "third party payor."
Elisa--I'm eager to hear from your readers: would they be willing to pay cash at the time of their doctor's visits, if their doctor's office provided the amenities you seek (phone access, secure online messaging, excellent teaching...what else?)? Thanks"
I left a responding comment on the original post, but thought this was worth discussing in its own post.
Here's the problem: there is a basic disconnect between who the service provider and the customer because of the insurance carrier.
My response to Stephanie was that I pay what I consider to be a hell of a lot of money for my health care. I pay almost $3K per year in premiums, plus co-pays, plus charges up to my deductible amount. That's more than my car payments. It is my single biggest expense, other than my mortgage and income taxes. And I pay it every month, so I'm constantly aware that I'm paying out.
So, I already feel like I pay a lot...yet Stephanie, as a doctor, doesn't see that money, doesn't touch that money. And has to wait an unacceptably long time for whatever small portion of that money she gets. I feel her pain. I'm in business for myself. My invoice terms are Net 30 days. But usually I'm billing on services already rendered. So, waiting 30 days hurts a little. Late payments from clients hurt a lot. I get it, really I do.
So, what if health insurance was composed of two modules: catastrophic and maintenance? Make catastrophic a mandated, single-payer system. Everyone paying into a big pool to help anyone out who ends up in a car accident, or with cancer, or any number of other catastrophic medical problems. Employers could still offer to pay an employee's catastrophic payment as a benefit, just like health benefits now are basically an optional form of compensation. And there would still be social programs to account for the catastrophic program payments those who are less fortunate.
Now, when it comes to maintenance, people are on their own. Again, it would still be an attractive employee benefit to offer. Only now it would be in the form of payment into a health care account per employee. Again there would still be very basic programs set up for those at the lowest incomes. But no insurance company involvement. Patients pay cash to providers.
Well, I see two immediate problems:
One problem deals with the patients and is the continuing moral dilemma...is it OK that rich people will have better maintenance care than poor people? Sure, those poor people with crappy maintenance care will be more likely to end up needing catastrophic care, and at that point they're covered the same as anybody else. But it sure doesn't sound right.
But we probably have this very same thing happening right now...without even the safety net of catastrophic care, so would lower-income people really be worse off in practice than they are now?
But the second problem is for the doctors, because now they'll have to run themsevles like a business in a way they don't have to now. Do you see any ads for doctors? Yes...for plastic surgeons, for Lasix doctors, for other kinds of specialities that aren't covered 100% by most insurance carriers.
See right now you get a list of approved doctors and you just choose one from the list. Geography is likely a big factor. You might try to get recommendations, but recommendations are trumped by whether or not the doctor is on your list every time. If doctors get what Stephanie seems to be saying they want...a more direct relationship with paying customers...that's not just going to result in direct cash payments to them, it's also going to necessitate more traditional sales and marketing efforts.
It'll be a new world for most doctors too. Are they ready?
Maybe none of my ideas are new. Let's change that. Probably none of my ideas are new.
But you know you've got a disconnect when the doctor asks: "would you be willing to pay for service?" and I ask:"Aren't I already paying? Where's my $3K going then?"