Comments on: Hits & Misses – 2009/7/6

By: Dan S

Dan S — Tue, 07 Jul 2009 19:07:59 +0000

The comments section of the NYT article was closed, so I will vent here. Despite the assertion to the contrary, the managed care gatekeeper function 25 years ago was EXACTLY like the medical home being touted. I know, because I started my family practice career in 1982 and we used the same phrases: coordinate care, quarterback,focus on preventive care, keep people out of the ER and hospital. The payment mechanism was capitation. There has been little change in the playbook. OK, now the primary doc gets a fee for coordinating care, with bonuses for keeping people out of the hospital (saving money). Nobody is talking about cherry picking, adverse selection and trying to do the work of a specialist for a generalist’s fee. That is what is about to happen. I hate to rain on anybody’s parade, but we are about to re-live something that already happened. And the results weren’t pretty.

By: John Goodman

John Goodman — Tue, 07 Jul 2009 18:15:44 +0000

Marginal product is the value of the physician’s time devoted to different tasks. Ideally, you would like the physician to allocate his time so that he maximizes the value of care to the patients. In a market, that tends to happen naturally. In bureaucratic systems, it rarely happens at all.

By: Bart Ingles

Bart Ingles — Tue, 07 Jul 2009 02:48:17 +0000

A good primary physician– at least one who happens to be on the roster at your local hospital– can go a long way toward expediting any visits to the E.R.

By: Larry C.

Larry C. — Mon, 06 Jul 2009 22:11:14 +0000

What do you mean by marginal product?

By: Tom H.

Tom H. — Mon, 06 Jul 2009 21:19:43 +0000

As previously mentioned at this blog, the use of the emergency room did not change in Massachusetts,even after they “insured” half the uninsured.

By: Joe S.

Joe S. — Mon, 06 Jul 2009 19:38:05 +0000

On emergency room waits, You are right John. We are becoming just like Canada.