Recently I was in a group email discussion about primary care. This group is mostly people on the business/benefits side of healthcare. All members of this group have shown that they think the current U.S. healthcare system is wasteful and unsustainable. One of the members said that Medicaid increased primary care support in the past. Here was my response:

No effort in the U.S. has ever experimentally tried to match the observational evidence. The observational evidence is clear both in the U.S. and around the world (Barbara Starfield studies, etc.). Places with more family physicians/GPs have better health outcomes at a lower cost. No one has ever tried to match this finding by purposefully increasing the family physician supply in a geographic region and then following what happens next, comparing that region to other regions where no intervention occurred. The managed care era was a joke. Managed Medicaid is a joke. Assigning a Medicaid patient by a computer to a family physician 100 miles away was what they called enhancing primary care. The pay was pitiful. The metrics were meaningless. The panel sizes were a joke. Neither Medicaid nor anyone else tried to increase the family physician supply in any meaningful way over a sustained period of time. There were about 3 years in the 1990s where medical student interest increased, but as soon as the American people rightfully became enraged with the abuses of the managed care corporations, their support of family medicine crumbled right along with the whole HMO thing. Family physicians were the babies thrown out with the dirty managed care bathwater.

And this doesn’t even get into the payment bigotry of what Medicare and the other payers pay for things like sprained ankles and lacerations. I’m talking about what is “appropriate,” not even the ridiculous surprise ER bills. If a patient sees his personal physician for a sprained ankle acutely, the pay is substantially less than if they go the ER or an urgent care center. Urgent care centers are artificial constructs incentivized by insurance companies who wanted to pay less than ER rates, but for some crazy reason were not willing to support primary care centers to provide more coverage. The general lack of support of family medicine centers runs through all “appropriate” payments.

This entry was posted on February 6, 2022 at 8:50 pm and is filed under Blog. You can follow any responses to this entry through the RSS 2.0 feed.