Nate Duehr wrote:
> My wife worked in a private Doctor's office years ago.  He was being
> stretched thin by insurance companies, not of his own accord, and
> slowly being run out of business.  In order to accept certain
> insurance, he had to sign contracts that would put limitations on him.
>
> Some docs can't see less than a certain number of patients.
>
> They have a quota of patients to see in order to keep their status
> with certain insurance companies.  The insurance companies put a low-
> end cap on a base pay-out and all the patients below and up to that
> number are covered at a monthly flat rate, but you need to regularly
> see at least that many patients.
>
> The doctor doesn't get paid any real money until they see MORE than
> the average number of patients.
>
> Don't like it, ask the Doc which insurance companies do this and then
> convince your employer not to use that nice cheap HMO/PPO insurance.
> (Sure... right... uh-huh.)

[snip]

> It's an insanely corrupt business.  This doc was about three years
> from retirement when my wife left his office, and he admitted that
> he'd been operating the office in the red for about two years prior
> to her deciding to switch to home healthcare nursing.  He was trading
> away his money saved for retirement for the betterment of his low-
> income and financially challenged patients while still trying to hire
> quality (read: more expensive) office staff, nurses, etc.
>
> He was slowly going "broke".  No, he'd never truly be personally
> bankrupt, his practice had done well for years, but it was eating up
> a large chunk of his retirement nest egg to continue to retirement age.
>
> And losing money was a tax write-off for him, of course, so there was
> a minor upside... but there were many months in the six or seven
> years my wife was there, that the insurance companies were three to
> six months in arrears in payment, and he had to pay the payroll out
> of his own pocket.
>
> This is why you don't see single "family practitioner" offices with
> one or two docs in them much anymore.  They have to gang together
> into "groups" and hire a bunch of physician's assistants or nurse
> practitioners (my favorite - they listen, they've had virtually the
> same level of schooling and training as a family doc, and they're
> damn good people usually too -- having usually worked their way up
> from "regular" nursing jobs) to crank through the people there with
> minor afflictions (to keep up their insurance quotas, which they can
> collectively bargain in a large office with the insurance companies
> to some extent), so they can free themselves up for the REALLY sick
> folks.
>
> But the chaos and high numbers of people in the offices that run like
> that, lead to pretty impersonal interactions that are too fast, and
> generally poor quality.

So, what is the solution to this problem?

There are many things that are covered by insurance: cars, businesses, 
homes -- and there it seems to work OK.

If I accidentally make a hole in the wall of my house, I will pay the costs 
of patching it up out of my own pocket, without involving insurance. In my 
mind, insurance is for when things go really wrong (the house burns down, I 
total my car, etc).

How is medical insurance different? Why do the insurance companies do all 
the bad things that Nate listed above?

Vitaliy

PS As a semi-conclusion to the original post, I made an appointment with a 
doctor recommended by my cardiologist. I also found that asking perfect 
strangers about their experience with their doctor is a good way to carry on 
a conversation. :) 

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