Who Will Care for the Newly Insured?
Who Will Care for the Newly Insured? - Prescriptions Blog - NYTimes.com:
One of the big concerns is the operation of simple supply and demand: without structural intervention, the injection of much more demand and no additional supply will cause prices to skyrocket. The problem here, though, may be even more fundamental than that. The right services will simply not be available at any price. We need many more front line medical service providers than we have, and our current systems simply will not produce them.
I suggest changing the investment burden and incentive structure. Pay for medical school, or for most of it, but require 5 to 10 years of service as a primary care physician before a doctor can be certified in a specialty. This takes the pressure of $200 to $400K of debt off the doctors, while materially increasing the supply of the type of doc we need.
We will also need to look at expanding the type and number of non-physician professionals that can deliver primary care. Nurse practitioners, physician's assistants and others can provide much or all of the type of care that primary care providers do. Further, their training, while quite robust, can be more targeted at the needs of primary and community care.
We need to look at the whole supply chain if we are going to get the results we want. Just cranking up insurance coverage will not cut it.
This is another problem that will have to be addressed. There are already significant shortages of front line medical personnel in many parts of the country. The economics of the medical educational and delivery systems push doctors toward high-end specialties and away from primary care where they are needed most. The problem gets much worse if you suddenly put millions more people with insurance into the system.2013. That’s the year everyone would have to have health insurance under the House version of the health care bill. It may seem like the far distant future — especially if you don’t have insurance now — but many experts say it’s not nearly enough time to beef up the supply of physicians necessary to care for the tens of millions suddenly entering the health care system.
One of the big concerns is the operation of simple supply and demand: without structural intervention, the injection of much more demand and no additional supply will cause prices to skyrocket. The problem here, though, may be even more fundamental than that. The right services will simply not be available at any price. We need many more front line medical service providers than we have, and our current systems simply will not produce them.
I suggest changing the investment burden and incentive structure. Pay for medical school, or for most of it, but require 5 to 10 years of service as a primary care physician before a doctor can be certified in a specialty. This takes the pressure of $200 to $400K of debt off the doctors, while materially increasing the supply of the type of doc we need.
We will also need to look at expanding the type and number of non-physician professionals that can deliver primary care. Nurse practitioners, physician's assistants and others can provide much or all of the type of care that primary care providers do. Further, their training, while quite robust, can be more targeted at the needs of primary and community care.
We need to look at the whole supply chain if we are going to get the results we want. Just cranking up insurance coverage will not cut it.
That's an interesting and important piece of this whole issue that I hadn't even considered. At the risk of being too consistently positive: Thanks.
ReplyDeleteAn interesting and relevant component is a change in the level of education needed to be a Nurse Practitioner. By 2015 advanced practice nurses and other RNs going for NP certification will be educated at the doctorate level. Doctorates will not be required for NPs currently in practice. They will maintain authority to practice, as occurred when APN education transitioned to the master’s level.
ReplyDeleteNot going the right direction, then. Higher barriers to entry are not going to get us more front line care givers. I realize that there is a countervailing argument regarding quality, but I don't see the answer coming down the current path.
ReplyDelete