People who don't want expert medical advice go to the counter clinic, we don't have to serve resentful patients, and we can spend our time thinking about medicine with patients who appreciate our service.
Further, patients sometimes visit a counter clinic, but they have issues beyond what the counter clinic can handle. So, the counter clinic will refer the patient to us ---the medical doctors. One of our most regular patient referrals is corner CVS because the local medical doctors introduced themselves respectfully to the CVS clinic staff.
However, don't be fooled by the "cost cutting" nonsense. My estimation is that counter clinics increase total medical spending in the same way that shopping at Wal-Mart increases total consumer spending. Yes, each individual purchase of "health care" is moderately cheaper. However, given the lower prices, omnipresent availability, and cross-marketing of other products in the store, people do not simply buy the same things at a lower cost, they impulsively buy many smaller purchases of dubious value.
So, rather than visit an outpatient medical doctor for an hour for $500 (that is what we bill, though we usually only collect about $300 of that from insurance), one visits the Wal-Mart counter clinic for $70. That's a savings of $430, right? Maybe. Assume the counter clinic treated your sore throat, but you also had another issue, and later visited the medical doctor. Both issues could have been treated by the medical doctor for $500 now rather than $570 over several weeks. Oh, and you also bought "health supplements." Add another $30 recurring cost. Well, actually, you don't go to the doctor at all because you only have $500 for health care, and the doctor costs $500, but you only have $400 because you've already spend $100 on the counter clinic and supplements ---oops, actually, that $400 is already spent by your employer for health insurance.
So, you still pay, but you never visit a doctor, chronic heath conditions continue to exasperate, and in addition to suffering from chronic health problems, you eventually get very sick, progressively lose your ability to function, and are hospitalized sooner at a much higher cost.
Even a single day of missed work at $5 minimum wage due to illness not addressed by a counter clinic is quantitatively worth more than the $37 best case savings at the counter clinic. Primary and preventative care alternatives are almost never "cost savings" unless you know precisely otherwise.
By the way: there is some ludicrous cultural myth that exasperated health problems can be "fixed," or if you can just avoid "having a a serious problem" and "keep natural," you will be OK ---or at least, you can "fix" health "issues" "later."
No, you don't. You die.
Also, jeez, you spend so much time and money making your face and buying clothes, but when you have a disease, you're thinking about saving a few dozen dollars? Bleh.
The same with medical tests – the doctors draw blood and send it to a pathologist. They then charge you a 400% mark-up on that and make pure profit. Then it is the unnecessary x-rays (if the doctor happens to have a digital x-ray machine that he is itching to use).
If a doctor prescribes anything he will prescribe the most expensive antibiotics ever – even though a much cheaper run of the mill one will work as well (I don’t know why they do that).
Why do they want routine appointments (once a month) for chronic medicines?
No offence, but I think modern day doctors focus on ripping off medical schemes because there is no apparent victim.
Assuming you are a programmer, why should I pay to use your software? I would prefer to pay nothing because it doesn't "cost anything" to copy it. Oh, well, ok, I'll pay for my 10 minute share of your time at $40 / hour. You have to eat, too.
> If I have Bronchitis I know exactly what I need and the doctor knows it too.
Great. Go visit a counter clinic and get exactly what you need ---though I'm sure you know that you have acute viral bronchitis and you only needs some over-the-counter drugs to treat symptoms. Then, you can go reinvest your "shitload" in something more intelligent like car insurance or a new graphics card. Like, your lungs are fine. I'm pretty sure all lungs have been fine forever for everybody, and if not, well, you can buy a new lung from the lung store and swap it in for all those shitloads you saved in ten minutes years ago. It will probably even be a better lung than your old obsolete one.
"The same with medical tests – the doctors draw blood and send it to a pathologist. They then charge you a 400% mark-up on that and make pure profit."
You're right. Health care should be like sex. Free only, illegal otherwise, immoral regardless. There should be laws to enforce this.
"Then it is the unnecessary x-rays (if the doctor happens to have a digital x-ray machine that he is itching to use)."
Say no.
"If a doctor prescribes anything he will prescribe the most expensive antibiotics ever – even though a much cheaper run of the mill one will work as well (I don’t know why they do that)."
Did you ask?
Also, doctors prescribe generally prescribe what will be most likely to work the fastest because ---if you remember from a century ago--- bacterial infections kill you and then spread to your friends and family to kill them. They don't care that you can save $30 with some similar drug they don't know much about.
"Why do they want routine appointments (once a month) for chronic medicines?"
Because
"No offence, but I think modern day doctors focus on ripping off medical schemes because there is no apparent victim."
If you know some rip off scheme perpetuated by licensed medical doctors, write it down and submit it to a medical journal. I think modern day people focus on engorging distractions while they mindlessly spawn and decay because there is no apparent victim. No offense.
The basic care that you receive will come from a physician assistant/nurse practitioner. This dramatically cuts down on cost while mantaining an adequate level of care. Physicians are going to continue to become more and more specialized. Which leads to physicians only providing specialized/unique treatments.
If you have 45 minutes to kill, you can listen here (http://dpcare.org/wa_health_underwriters) to a Seattle doctor talk about the issues, his company's approach, and why direct primary care is such a good thing. He advocates concierge care as opposed to the Walmart care discussed in the article, and I find the approach to be more sound. His approach is like Performace Based Logistics for medicine--the doctor that keeps you healthier makes more money, and I like that incentive. Nonetheless, both his solution and the Walmart solution are attempts at taking advantage of the same idea: paying directly for primary care can both lower costs and improve quality because the time and money required to pay for routine things with insurance is so terribly high.
I am convinced we are witnessing the birth of a revolution in medical care. I pay out of pocket for primary care, even though my insurance would cover everything if I went to a traditional provider. The new way is that much better than the old way -- and that cheap.
I agree that concierge practices sound like a better approach, at least as a primary source for health care. It would be the same as insurance for the smaller things. Leaving insurance to cover larger things. As far as I can tell the worst of the problem is caused by insurances and the related need for medical billers. Another interesting group are the Ideal Medical Practice Doctors. They work with minimal staff and use cheaper technology so they can lower the cost per patient and spend more time with the patients. One doctor I have heard has zero staff.
I wonder if having a small number of doctors available to these nurses could improve treatment by allowing more patients to get a doctors opinion (somewhat in the same way e-mail and IM tech support allows each technician to server more people than phone support). Could they treat even more conditions that way?
It seems a setup like this with some technology checks and balances (to make sure the right questions get asked) could make health care a lot more efficient.
http://ecwblog.blogspot.com/2008/02/walmart-rediclinic-eclin...
http://www.redorbit.com/news/health/1501613/rediclinic_to_le...
Instead of talking to people, you'll stick your arm in one machine socket and spit into another and it will take your blood and analyze your fluids for the flu, a dozen diseases and genetic defects. Then it will print out a prescription with a credit for the store it's located in.
You'll be force-fed advertising while the process happens and then they will sell the results to various other corporations which will then market you cures. They'll be able to do this because they will flash an EULA on the screen waving all your rights, which you have to agree to so you can get help.
Then the medical vending machine corporations will have a massive lobby for their rights in Congress which cannot be defeated because they will get the loons on their side to defend their massive profits as "American Values".
