Patchwork Solutions
Jan 10th, 2008 at 9:01 am by Susie
The United States healthcare system - held together with string and chewing gum! From today’s Boston Globe:
After state regulators cleared the way yesterday for store-based medical clinics, CVS Corp. said it plans to open more than two dozen inside Massachusetts drugstores this year, dispensing treatment for bronchitis and earaches a few aisles away from shelves of candy and nail polish.
The vote by the Public Health Council marked a signal and controversial shift in the healthcare landscape: The CVS MinuteClinics will be for-profit operations staffed by nurse practitioners only, in a state where medical treatment historically has been the province of not-for-profit hospitals and physicians working in mostly large group practices. Other pharmacy chains and retail stores, as well as hospitals and community health centers, could also open limited service clinics.
The members of the council, which sets policy for the Department of Public Health, anguished over their decision, torn by a desire to improve patients’ access to routine care - the clinics will be open nights and weekends - but not to substitute episodic treatment in a store for an ongoing relationship with a doctor.
Still, the eight members of the panel who voted in favor of the clinics and even the five who abstained said this was the right time to expand access. There is a shortage of primary-care physicians, leading some patients to turn up in hospital emergency rooms for routine care - and that was before nearly 300,000 previously uninsured Massachusetts residents gained coverage as part of the state’s near-universal health insurance initiative, expected to spur even greater demand.
In approving the clinics, the council insisted on strict patient safety provisions and required that each clinic be individually licensed by state overseers.
Ronald Preston, a former top health official in Massachusetts, described the clinics as “an entirely reputable business.”
“If they’re well-run and they stay within certain parameters, they fill a need,” said Preston, now a private healthcare consultant who is also on the faculty at the University of Massachusetts Medical School.
“My issue with them,” he said of the clinics, “is what they say about the whole healthcare delivery system: The primary-care delivery system in this country is dying. The reason why these things have become important is because there’s this big hole in the delivery system.”
As you say, the best healthcare in the world. Yay.
The biggest issue that this doesn’t and can’t address is the declining number of primary care physicians. Which results from a variety of economic factors from the high cost of medical education, the relatively low pay when compared to specialist, to the high cost of malpractice insurance. On the malpractice insurance that is from a number of sources from a few bad doctors, greed on the part of insurance companies, to over zealous and downright sleazy trial lawyers. Until we tackle these factors there is going to be no solution and just going to a single payer system won’t cure it. In fact it could make the problem worse at first as additional people flood the system and very likely doctors slow down their work over issues of reimbursement levels.
best union in the country has to be the AMA…talk about controlling the supply
[...] dellaanastasiades wrote an interesting post today onHere’s a quick excerptAfter state regulators cleared the way yesterday for store-based medical clinics, CVS Corp. said it plans to open more than two dozen inside Massachusetts drugstores this year, dispensing treatment for bronchitis and earaches a few … [...]
I see this as part of the larger pattern of all sorts of things being privatized and given to large corporations. There seem to be a lot of evil geniuses out there who are able to come up with ways to turn things that don’t seem at first glance to lend themselves to being run by corporations (schools, for example) into big profit-centers. So now someone’s found a way to take over the work done by doctors in private practice.
I’m reminded of Walmart pushing all the mom-and-pop stores out of business. Ronald Preston’s worried that the primary care delivery system is dying? Well, take away lots of its business — all those kids with ear infections, all those people who are worried their colds have turned into bronchitis, etc. — and see how well it does then.
Also, how much effort do you think CVS is going to put into keeping all that patient information confidential? When this comes to Cincinnati, I’m sticking with my internist, thank you.
Whenever any change is contemplated regarding the status quo in health care, people tend to rail against the fact that the change doesn’t go far enough, or it doesn’t address the “real” problems in the health care system. The introduction of these clinics in Massachusetts were never meant to cure all that ails the health care system. Instead, it is hope that they will provide basic, affordable care for minor health care needs in a safe and convienient way. Hundreds of these clinics are opening up around the country and the people that use them actually like them. Imagine that, delivering health care in a way that is geared toward the consumer.
Also, the Massachusetts regulations were broadened to allow non-profits to open mini-clinics. Hospitals and community health centers can also participate in this new delivery system.