I know OB/GYN's get some of the highest liability rates, but they're also a pretty large group of all doctors. I mean, everyone here has depended on one at least once (save for those who had crazy parents who hated doctors), and most of the females here will be in need of one at least several times.
. . .
I actually mention it because I figure it's the one doctor everyone has had some experience with. (even if it was as a newborn)
Not so -- Family practice doctors also deliver babies. I stayed with my regular FP for both of my pregnancies.
Posts: 9866 | Registered: Apr 2002
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quote:Originally posted by dkw: Not so -- Family practice doctors also deliver babies. I stayed with my regular FP for both of my pregnancies.
I'll be honest in saying I haven't met anyone that I know of who's stayed with their family doctor through the whole process, and didn't even know people did it. (of course, I haven't asked nearly everyone I know what they did, so it's very possible some of them have) That being said, how many people do so percentage wise? What's the liability insurance like for FPs who chose to deliver babies? Is it the same as for OB/GYNs? Sorry, I tried to do a little googling, but I'm too tired/lazy atm. I'm curious to know, though.
Posts: 2222 | Registered: Dec 2008
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Midwives also perform prenatal care and deliver normal pregnancies. Certified Nurse Midwives even do so in a hospital setting.
Posts: 101 | Registered: May 2009
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quote:Originally posted by ClaudiaTherese: They are out on the thin edge of a very, very long wedge. You can't extrapolate about general malpractice issues from the Ob-Gyn situation, although it's bad enough all around. It's just that it is well beyond the norm in that corner.
I was really really hoping CT would weigh in on this whole "medical care reform" issue,... but I was hoping for a bit... more.
See ... below.
[Added: What a vote of confidence, or at least interest! Thank you -- I am delighted you thought of me, and when there is time and energy, I will try to do better for you.]
quote:Aren't you practicing now where there is a single-payer system, CT?
Right now I am in New York, as Canada does not consider me sufficiently trained for another year, although I satisfy the requirements for the US. Oh, well -- the path of true love is never easy.
quote:So you can give a better comparison of the two systems (from a physician's standpoint) than anyone else here has any idea of?
Ah, that's what I've been doing for the last 8 or more years here. *smile
It's a conversation I've been having / trying to have over and over and over again at Hatrack, including block-quoting myself (a sign of megalomania if there ever was one! ). Now that the general zeitgeist has picked up the issue, I'm happy to sit back and carry on with my own bidness. Y'all will figure it out.
My summary, should it be useful, even if far too sparse for what someone might want [but it's the best I have in me for now, as the roller-coaster of life has picked up speed again, alas] is this: I am looking forward to getting back to Canada, both as a physician and as a patient. For details, see the last 8 plus years of posts. Posts: 14017 | Registered: May 2000
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Blayne Bradley
unregistered
posted
We need someone to compile a list of those posts in a single thread so we ay cross reference with them!
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quote:Originally posted by ClaudiaTherese: They are out on the thin edge of a very, very long wedge. You can't extrapolate about general malpractice issues from the Ob-Gyn situation, although it's bad enough all around. It's just that it is well beyond the norm in that corner.
Eh?
Yep.
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quote:I know OB/GYN's get some of the highest liability rates, but they're also a pretty large group of all doctors.
quote:Family physicians, internists, and pediatricians all paid a median of $12,500 annually for med-mal coverage, based on the survey. Ob/gyns forked over more than four times as much, because of their propensity to be sued.
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quote: ... I'd say OB/GYNs are a sizable chunk of doctors (if not the largest chunk)
???
Internists are the largest single group at 15%, followed by family medicine physicians at 12.3%. Together they make up over 1/4 of all practicing physicians in the US.
Again, OB-Gyns make up less than 6%, and they face disproportionately high challenges in this area, especially as of late.
--------------------------------------
Edited to add: All I'm really saying is that the extent of the challenges facing OB-Gyns are not representative of the challenges facing the general profession as a whole. It's a matter of degree, that's all.
Posts: 14017 | Registered: May 2000
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quote:Originally posted by Mucus: The insurance model IS a strange one for health care. I saw a post on this earlier today.
quote:For all of these reasons, you can’t count on your health insurer being there when you need it. That’s not insurance; that’s employer-subsidized health care for the duration of your employment.
That's the best description of it I've seen yet, Mucus.
Personally, I think we need a two tiered system. We should be able to buy private insurance and have an easy time getting in to the doctor for routine stuff. But we should have government care for the big problems. Chronic conditions, birth defects, cancer. We as a whole should be stepping in to pay for these things.
I'm not sure I've heard anyone dispute that. The question I hear most often is, "How will we pay for it?" If leukemia costs a million dollars to treat and about 120,000 people were diagnosed last year, where are we getting $120,000 million dollars? (That is 120 billion, right?)
The biggest problem I see with government health care is that it's going to put other people's blood directly on our hands. At some point, we're going to say, "This is too expensive, we can't pay for this," and someone is going to die.
Right now, bureaucrats killed that person. If insurance were different, if life were more fair, they would have lived. But if we could save them and chose to spend our tax dollars rebuilding old bridges and buying a new wing of jet fighters and hiring more school teachers, then we with our priorities killed them. When push comes to shove, no one wants to be guilty.
In the end, life isn't fair, and I'm not sure we can save everyone. But how do you push through government health care to save everyone and then still let people die because of money?
Posts: 2283 | Registered: Dec 2003
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quote:Originally posted by Jamio: Midwives also perform prenatal care and deliver normal pregnancies. Certified Nurse Midwives even do so in a hospital setting.
Yep.
I went to an Gynecologist only because I had trouble conceiving. Once I fell pregnant, I had midwife care through the entire pregnancy and labour, in a hospital setting. If I had been able to fall pregnant without intervention, I would never had seen the gynecologist.
Posts: 4393 | Registered: Aug 2003
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quote:The biggest problem I see with government health care is that it's going to put other people's blood directly on our hands. At some point, we're going to say, "This is too expensive, we can't pay for this," and someone is going to die.
You have that now. You will never not have that.
The issue is that the way it works in America is a worse process for determining who we 'can't pay for' — in most cases involving exorbitantly expensive conditions, the process that decides whether or not you will receive coverage is based on whether or not the coverage denial teams at your insurance provider, who get dispatched to your case the instant this happens, can find a way to loophole you out of coverage or exclude you via restrictive legalese.
Much more 'blood' is 'on our hands' for virtue of our national recalcitrance to fix a broken system.
Posts: 15421 | Registered: Aug 2005
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posted
AvidReader, I'd do it exactly the opposite.
There's no real profit in general preventive care, IMO. It's a fixed cost... And it's essentially insurance companies trying to insure against massive numbers of catastrophic care, so they can maintain a working business model.
On the other hand, not everyone dies of cancer, or some horrible and expensive disease. Let insurance companies duke it out for this area, which would actually be health insurance, as opposed to health care.
quote:There's no real profit in general preventive care, IMO.
I think that's the problem, really.
Granted, preventive care is cheaper, in the same way that maintaining anything is generally going to be cheaper than replacing it, but that's only half the equation. I've read stories where hospitals have had to cancel diabetes maintenance programs that were making people live fuller and healthier lives with far fewer complications because they couldn't afford it. But when those same people came in later requiring expensive amputations because they weren't taking care of themselves, the hospital made money off it.
It's always going to be cheaper for an insurance company to deny coverage and ignore preventive care, just like it's cheaper for a hospital to ignore it and wait for the expensive problems to come along so they can make money and keep their doors open. We have a seriously assbackwards set of priorities when it comes to health and wellness in this country.
Posts: 21898 | Registered: Nov 2004
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quote:Originally posted by Lyrhawn: Granted, preventive care is cheaper, in the same way that maintaining anything is generally going to be cheaper than replacing it, but that's only half the equation. I've read stories where hospitals have had to cancel diabetes maintenance programs that were making people live fuller and healthier lives with far fewer complications because they couldn't afford it. But when those same people came in later requiring expensive amputations because they weren't taking care of themselves, the hospital made money off it.
You heard this from me. Which I'm pretty jazzed about!
quote:In the Treatment of Diabetes, Success Often Does Not Pay
With much optimism, Beth Israel Medical Center in Manhattan opened its new diabetes center in March 1999. Miss America, Nicole Johnson Baker, herself a diabetic, showed up for promotional pictures, wearing her insulin pump.
In one photo, she posed with a man dressed as a giant foot - a comical if dark reminder of the roughly 2,000 largely avoidable diabetes-related amputations in New York City each year. Doctors, alarmed by the cost and rapid growth of the disease, were getting serious.
At four hospitals across the city, they set up centers that featured a new model of treatment. They would be boot camps for diabetics, who struggle daily to reduce the sugar levels in their blood. The centers would teach them to check those levels, count calories and exercise with discipline, while undergoing prolonged monitoring by teams of specialists.
But seven years later, even as the number of New Yorkers with Type 2 diabetes has nearly doubled, three of the four centers, including Beth Israel's, have closed.
They did not shut down because they had failed their patients. They closed because they had failed to make money. They were victims of the byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications.
Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.
Patients have trouble securing a reimbursement for a $75 visit to the nutritionist who counsels them on controlling their diabetes. Insurers do not balk, however, at paying $315 for a single session of dialysis, which treats one of the disease's serious complications.
Not surprising, as the epidemic of Type 2 diabetes has grown, more than 100 dialysis centers have opened in the city.
"It's almost as though the system encourages people to get sick and then people get paid to treat them," said Dr. Matthew E. Fink, a former president of Beth Israel.
Our diabetes issues are entirely self-inflicted. And a large percentage of these uninsured diabetics have their condition grow so poor that they become wards of the state; the inefficiency of the private system turns into your problem the second they fall into Medicare/Medicaid.
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posted
Diabetes complicates just about everything in the medical realm, since one of its hallmarks is impaired healing. When someone gets an infection or inflammation, it takes much longer to heal or it never fully does, leading to more complications, more infection, more scar tissue in internal organs, all of it.
Pneumonia Cuts and scrapes Heart attack Stroke Flu Hepatitis Gastroenteritis Surgery Dental/gum infections Sinus infection Fungal infections of the nails Folliculitis Shingles Pancreatitis Kidney infections UTIs on and on and on
Just about anything physically that can be made worse is made worse. If there ever was a place to spend money to save money in terms of relieving the stress on the healthcare system, diabetes is it.
Posts: 14017 | Registered: May 2000
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quote:Originally posted by Bokonon: AvidReader, I'd do it exactly the opposite.
There's no real profit in general preventive care, IMO. It's a fixed cost... And it's essentially insurance companies trying to insure against massive numbers of catastrophic care, so they can maintain a working business model.
On the other hand, not everyone dies of cancer, or some horrible and expensive disease. Let insurance companies duke it out for this area, which would actually be health insurance, as opposed to health care.
-Bok
I'm not sure it matters who's paying if we take cancer off the table. All we need is a payment structure where wellness is valued over quantifiable things treated. The insurance companies and the AMA could probably work out a new fee structure themselves without any need for new legislation if someone could make them see the advantage.
After all, it's only more expensive to do it the way we do now because numbers on a piece of paper say so. We can change that. Maybe the doctor who didn't follow up with the patient would have to pay a large surgery penalty if they needed hospitalization within some time frame. Or hospitals who run chronic care clinics might get a percentage of the surgery fees that they prevented based on the number of clients they maintain.
I would still like a safety net for people who can't work. Laws saying insurance can't deny them for pre-existing conditions is great, but what do they do in the meantime? Maybe temporary Medicaid benefits when you file for unemployment? More incentives for free clinics in rural areas? Losing a job shouldn't mean you can't afford to go to the doctor.
Posts: 2283 | Registered: Dec 2003
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Are you a liberal if you want to see an overhaul of the health-care system?
No.
You are probably a conservative business owner or you want to be. That is unless your business is in the Insurance, Drug, or Hospital field--and many of them are wanting change as well.
According to standard business theory, any cost that does not directly aid in production is waste.
Health Insurance for employees is a perk, an employee benefit that helps keep and motivate the best people to continue working at (or come to work for) your company in a dedicated way.
However the cost of the perk, that incentive, continues to rise while the benefits of each plan are diminished. The employer only sees the costs going up and is frustrated that the employees don't appreciate the extra expense being paid for their benefit. The employees see the amount that insurance is costing them continues to rise and get frustrated that the employer doesn't appreciate that this rise in costs is such a burden.
From the employers point of view, the status quo is creating waste--an employee motivation and retention tool who's cost rises as fast as its benefits (in employee motivation and retention--ie employee happiness) drops.
So even the most $ Conservative business man realizes that change must come.
Posts: 1941 | Registered: Feb 2003
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quote:From Samprimary: You heard this from me. Which I'm pretty jazzed about!
Ah! I've been telling that story, among others I've read elsewhere (but yours is usually first because it's so striking and easy to understand) for ever and I could never remember where I first read it. Thanks a lot Sam!
It's a horrible, backasswards problem in our healthcare system, and it's both incredibly wasteful and leads to such suffering for those afflicted. I say that as someone whose family is RIDDLED with diabetics, and also in general as someone who utterly hates waste. I wish we could, as a nation, simply look at the problem, see that one solution could save both money and improve people's lives, and just do it. But it's built from the ground up in a horribly inefficient way that provides are less quality care.
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). Now that the general zeitgeist has picked up the issue, I'm happy to sit back and carry on with my own bidness. Y'all will figure it out. ![[Wink]](wink.gif)
