RE: Is there a "Medical Mafia"?
I am not sure what your question about referrals is all about - much of the US practices the gatekeeper concept - your GP screens you before sending you to a specialist so that the specialists aren't overburdened with cases that really have no call seeing them. HMOs in the US practice closed shops, meaning that the referrals are to other doctors in that HMO scheme, although there are insurance companies that practice open referral policies, meaning the gp can refer to any specialist who will take the patient. I am unaware of kickbacks - I have never been asked for any and have never paid any. Sometimes specialists and gps know each other socially, but the bulk are either in the same insurance plan and are therefore on a list of permitted doctors or are, like here, often practising in the same neighbourhood or are known to the referring gp. I tend to send people to specialists that I know to have a good reputation, and avoid sending them to ones I either don't know or have heard that they don't know their fibula from their ileotrochanter. And trust me, word DOES get around.
Publishing service charges is a nice idea, but then the doctors have to do flat rate charges, and most insurance schemes in the US (and here)don't like that idea, nor do most doctors. A law passed last year here putting hospital surgeries under flat rate charges has shown to be financially disastrous for many hospitals - although it keeps insurance costs down a bit, there is always unexpected costs, and the hospital has to eat them, which means the Kantons (states) have to cover the costs for the overages, and that means the tax payers are covering it.
The tax-point system we employ here is pretty strait forward and simplifies the billing system a bit. But even then it doesn't always work so well, as you run into situations all the time that fall between one tax-point and another, and that means you either over or undercharge for a procedure, even if it is only a few franks. A good example would be the basic exam time: the first five minutes is a flat rate of 60 franks (set by the government, not us or the insurance companies, btw), and then there are two additional five minute flat rate tax points, after which you charge by the minute. All fine and dandy when your patient takes 17 minutes to treat. But if they take 7 minutes? Or 12 minutes? Do you charge only the first tax point for the first case or two tax points? In the second case do you do three tax-points or two? Are you under charging or overcharging? While it may seem simple to you, I assure you it is not - and we are a bit hamstrung by "official" guidelines in that respect, too. Now, we have time and again suggested to the health minister to change it so that we can charge either by the minute after the first 5 minutes or by the 5 minute period, but there are civil servants advising him that that would be a bad thing and would lead to abuse of the system, although I suspect there are more abusing the system the current way than we know of. I am the generous type and tend to round down if they are only a minute or two over. My secretary is not happy with me for that.
Unlike pharmacies, most doctors don't have card on the wall explaining the charges for a bandage or whatever. It is counter productive and most times would be rendered useless by the problem at hand. And how would we explain the nuisance tax-point (yes, we have that too, thank the gods!)? we all have our fair share of nuisance cases and time wasters and but-inners here, mostly because we DON'T have the gatekeeper concept here, nor HMOs (the Swiss people overwhelmingly rejected a proposed government mandated HMO scheme here last year in one of our quarterly plebiscites (we vote on just about everything at least four times a year at all levels of government - Switzerland is one of the few true democracies on the planet (and no, the US isn't one - it is a Republic) and so we get to busy body into everything all the time here))). I do think there should be in the US a basic flat rate for the first 5 minutes, just like here, and yes, you could publish that, but a list of fees for disimpacting a bowel or whatever? Really? No, I don't see that as workable. We do too many different things to patients to make that a viable idea. For big things, I do give cost estimates to patients, to give them an idea of what they might be getting into, or more often to discourage them from getting into it if at all possible (you would be surprised how many come it wanting an MRI for pretty much nothing worth putting under the Torus, until I make it clear that they will have to lay out 900 franks for it, and even then if they are well insured, they'll do it anyway). But for, say, cancer patients, there is no way I can give an estimate, since there are far too many factors involved to work out ahead of time what it will cost them for anything during their treatment arc. Medicine is a very flexible thing, and no two patients are alike in their needs or costs. Flat rates would be possibly ruinous for many practices.
(This post was last modified: 06-23-2013 06:04 PM by DocWils.)