This just in. A doctor who works at an academic hospital in Texas reports that he recently received a letter from the CEO of the hospital congratulating him for the high number of MRI scans he ordered during the prior month. He had never seen such a letter before, and wasn’t in the habit of ordering MRIs on patients unless they were medically indicated. In this case, it was coincidental that he had ordered so many that month.
Citizens of the United States: Do you know what this means? It means that the profit motive in healthcare delivery no longer hides behind a veil of professionalism and respect for patients. It is now openly accepted, even in academic centers, that patients are viewed as nothing more than walking ATMs. At least in Texas.
He goes on to tell about how the new dean hired a firm to come in and teach the administration and doctors how to maximize their use of revenue producing services and minimize those that don’t. Specialists were encouraged to take on new patients just long enough to run a slug of expensive tests and quickly discharge the patients back to their primary care doctors as soon as they had extracted as much revenue as they could. I don’t know if there are kickbacks for ordering tests, but it wouldn’t surprise me.
After twenty years of practicing medicine in the U.S., I now live and practice in Canada. I don’t miss the American system in the least. In Canada, healthcare is considered a moral enterprise. Even so, doctors earn as much or more than their counterparts in the United States. MRI machines are purchased by the Ministry of Health, paid for through tax revenues, and are used as needed with no charge to patients.
Many Americans may find it sad that no profits are to be made off an MRI machine in Canada, or unconscionable that their tax dollar might be going toward someone else’s MRI. Personally, I view both as doing the right thing. No conflict of interest for doctors, fewer unnecessary tests ordered, no concerns that patients won’t get the test, and so on. The same applies to doctor visits, other tests, surgeries, chemotherapy, hospitalizations, and most drugs for those qualified by age or infirmity.
None of this is new, just a reminder. Obama’s reform may be a step in the right direction, but for-profit healthcare is a runaway train in the U.S. and will require more drastic changes than Obama’s to slow it down. Read Atul Gawande’s fine article in the New Yorker to get the whole picture.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
