Re: OT: capitation (was Re: Occupancy and Security PIR - Suggestions?)

[Nelson Muntz <none@xxxxxxxxx>]

E. Hill wrote:

>> I can see why.  When the doctor has a choice on whether or not to do
>> diagnostic tests, under the capitation system he will most likely opt
>> for 'not'.
>
>You'd like to think that never happens, but I would tend to guess it does.

I know it does.  My mom is a nurse.  She told me a story about some
woman that came in the hospital with blatant dimensia.  My mom was
telling me how sorry she felt for the woman and her family because the
woman was only in her 60's.  When I asked her what a doctor would do
to treat it - she said the doctor replied, "I don't know - admit her
if she has insurance".  I think that is so sad, because that woman is
someone's mother - and the doctor is willing to let her slip through
the cracks unless she can pay for help :-((


>
>> Pretty much.  I had no clue what capitation was.  I always thought my
>> insurance paid for line-item stuff.
>
>Oh, it gets worse in many regards. One day I'll try to write an op-ed for
>our local newspaper. Putting it all down on paper so that the average person
>wouldn't get lost after the first paragraph... That would be tough.
>
>Not that you wouldn't get it... You would. It just would be very time
>consuming to write it all down and edit it.

Be sure to post it here.  Nothing is off topic.

>
>> I do, not to extent that you do though.  I know some victims.
>
>Me, too. Not personally. But, working in the industry, I hear about them
>from time to time.
>

I'll bet.


>> I think the current system should remain in place, but I have issue
>> with some things.  Insurance premiums are so high because it
>> subsidizes hospital's costs for 'free' work.   Massachusetts recently
>> made good legislation concerning heath insurance, I'm sure you're
>> aware of it.
>
>That is absouletry true! And, that brings us to illegal immigration (in many
>states), and the welfare mentality (which applies everywhere).

I was going to bring up wetbacks... But I thought I'd wait until the
thread evolved on it's own volition.  Now that it has, you bring up a
HUGE point.  Since ER's have a policy of turning down no-one, the
illegal's are using them as a general practitioner (herein known as
GP).  This is a huge burden on our hospitals.  When Pedro's kids get
sick, or need shots... who pays?  You do.


>
>Another reason premiums are high is because medicine is bad business. Case
>in point...
>
>Couple years ago, one of my friends gets a heart valve replacement. He moves
>from job to job, and I know there's no way he has money to pay for that. He
>doesn't have insurance. I asked him, "Who paid for that?" He thinks for a
>moment, and says, "I guess you did."
>
>I'm not advocating my friend die. The discussion hits a little closer to
>home when it's *your* friend or family. But, the reality is, years ago,
>heart valve replacement was not main stream, and it would not have been
>performed on an "indigent" case. He would have died.

I remember a situation where a convicted murderer in prison, who had a
death sentence got a triple bypass.  I still have not decided if that
was right or not.


>
>My point is... Techology marches on, but we (as a whole) don't have the
>money to pay for the technology. But, because doctors and society (as a
>whole), do have compassion... My friend lives, on our dime.
>

I'm glad your bud is doing fine.  Thanks to modern lifesaving
technology and compassion (which is why 99% of doctors ARE doctors)
you still get to enjoy his company.


>> Emergency rooms should only handle EMERGENCYS..  I sat for four hours
>> one time with a dislocated shoulder in the ER in agony - as I watched
>> one nappy-head-ho after another go before me because they were
>> probably drug-seeking or their 16th kid had a fucking sniffle.  The ER
>> is NOT the fucking clinic.
>
>Bingo. There needs to be a good incentive for people to have a primary care
>doctor, and a good disincentive if you visit the ER without a real
>emeregecy.


Yup.  And they need to adhere to triage protocol in the ER's.