Thursday, February 16, 2012

Efficiency is good for me

Sometimes I worry that I'm turning into a mindless enthusiast for my health maintenance organization ... but I hope I can claim to have kept my critical faculties.

But when I read something like what follows in Consumer Reports on Health, I thank my lucky stars that when I left the last employer who had me on a group plan, he'd recently switched us to Kaiser Permanente and that I've been able to stay with this HMO ever since.

Here's a bit of the article that inspired the thought:

Too much medication?
When was the last time you gathered up all your medication and took it with you for a check up? ...

A medication review is "one of the single most important things that happens in the context of an office visit. " says Jerry Gurwitz M.D., chief of the division of geriatric medicine at the University of Massachusetts Medical School in Worcester ...

Many people aren't taking the right medication. About 60 percent of those taking five or more prescription drugs [ [half of us over 57!] had at least one that was unnecessary ...

That's something I'm never going to have to worry about with my doctor. At Kaiser all my medical records are computerized. Any drug I have ever taken or am currently taking pops up on the screen when any doctor or specialist meets me. If there are known interactions between drugs I've been prescribed, the screen will also flag that.

Perhaps as importantly, it is in the interests of Kaiser to keep me on no more drugs than I really need; the organization's incentives are to keep me healthy and see me less, not to perform repeated procedures. I'm sure that if I had some medical condition that was extremely unusual, Kaiser might also have an incentive to deny me access to expensive tests or a rare specialty. But most of what makes most of us sick is pretty ordinary; doctors see the same conditions every day. For those ordinary problems, the structure of an efficient HMO avoids over treatments.

The health insurance reform that will kick in over the next few years, assuming Republicans don't run Obama out of office, aims to push these efficiencies into more corners of the medical system. This doesn't scare me; I've gotten my health care from such a system for over a decade and the experience makes me confident this is a smarter, better way. Thrive, indeed.


Darlene said...

I am praying that the Democrats control Congress so that the Republicans will not be able to repeal any or all of the Obama care.

I also hope they will improve it with the Public Option. Best of all, would be the single payer plan.

janinsanfran said...

Hi Darlene -- agree that we really should have gotten less of a Rube Goldberg edifice for health care!

But the kind of HMO I'm a member of has some of the good features of a single payer system. We pay for our insurance; we pay small co-pays. In return we have a main doctor and access through her (or direct if need be) to specialists including eye doctors, dermatologists, etc. -- the sort of doctors that are usually in another office or even "out of network." In return, the docs have our records and are on salary at the HMO.

In case of injury while traveling, we can go to any emergency room; I know because I've done it. There was no hassle getting the bill covered. (SHOCK!!!)

Kaiser really works pretty well -- unless perhaps you have something very unusual. But what does work, except wealth, for getting treatment for something unusual?

Rain Trueax said...

I am happy with our HMO and we have been in one HMO or another, at the same clinic, since we moved to the farm in 1977. It doesn't push to have you visit all the time. The last time I had a physical, my doctor did ask me to bring in everything I take which included any vitamin supplements. It is now all computerized also; so that if I have to go their Immediate Care clinic, the records are easy for my primary doctor to also see.

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