Ironic and ridiculous health care situation...

[Jolt]

I just recently signed up for one of the MA state health insurance plans since my employer does not offer insurance for people who work less than a certain number of hours. When one signs up, it is necessary to choose a primary care provider at that time so I chose a nurse practitioner in a large practice here in town. Today, I called to get an appointment for a physical since I will be starting school again in the fall and will need one. The woman on the phone stated that the practice is not accepting new patients with insurance but only those with free care/health safety net, unless you happen to be pregnant or HIV positive which I am neither. In other words, it appears that people with insurance now have LESS access to health care (at least at that particular practice). So, now I have to call the insurance company and get signed up with a new PCP or else go on a waiting list for that practice. Doesn't that sound like something straight out of an episode of Seinfeld?

[tulip]

Unfortunately, it sounds pretty normal. I think it's pretty commonplace to have to call around and see who is accepting new patients. I have my appointments at a large hospital, so there hasn't been an issue in general, but some of the doctors there don't accept new patients.

My insurance does not include dental coverage, so I go to the local dental school and get my teeth worked on by the dental students. It takes longer, but they do a good job and it's very reasonable.

BTW, I got individual coverage with a major carrier for a very good price through ehealthinsurance dot com. It can be had, at least for those of us without health issues, which doesn't make alot of sense...

[Blueberry]

What strikes me as strange are the kinds of patients they *are* accepting. Very odd.

But, there is a growing primary care shortage. Bottom line is there aren't enough docs now, even without everyone being insured. Sadly, being a primary care doc isn't as attractive to med students as specialties. I know the "whys" - it's just something we have to address.

[shootingstar]

Jolt, in Canada if you were a Canadian citizen/resident or had a work visa to work in Canada, you would receive general medical care within Canada.

As for dental care, no it is not part of our govn't supported medical insurance system.

My doctor (or her medical practice office staff) have no clue about my income. I just have the necessary health care ID and the process genuinely is examination/diagnosis from the attending physician.

As an adult patient I make the decision to give my consent (or not give consent) to my doctor to proceed with whatever treatment/surgery s/he recommends. There are times the patient for reasons might delay (if it's not urgent) or must find money for add-on costs (ie. a private hospital room is add-on cost borne by patient as direct cost or through work-related supplemental medical benefit. But a shared room with others is already covered.) It is not a private health insurance company that determines my eligibility for treatment due to cost coverage criteria.

Though the health care reform discussion is highly politicized and intense right now in U.S., what do TE members here think are the realistic areas for U.S. health care reform that is digestible and possible? Or is health care system so ensnarled with many bedfellows that it would be hard to even change permanently 1 part of the system in a major way without affecting another gigantic cog in the wheel?

[ilima]

What strikes me as strange are the kinds of patients they *are* accepting. Very odd.

But, there is a growing primary care shortage. Bottom line is there aren't enough docs now, even without everyone being insured. Sadly, being a primary care doc isn't as attractive to med students as specialties. I know the "whys" - it's just something we have to address.

Those are probably patients they can make a lot of $$$ off. Sad, but probably very true.

[Crankin]

Jolt, my son has the Blue Cross plan through the Connector. He goes to a doctor at the Brigham and had quite a choice of providers when he signed up. I think, unfortunately, you will have to shop around and find a pcp from the list they provide, instead of the one you want. I know the benefits he gets are quite good; everything except dental.
He works for a small company with 7 employees, so the state option was great for him. He had been paying for fairly reasonable private insurance, but this is a little cheaper. It is too bad that the practitioner you want to go to only takes the free care option people...
I know some think our state mandated insurance is "bad" or expensive, but for my son, it has only been positive.

[Jolt]

Jolt, my son has the Blue Cross plan through the Connector. He goes to a doctor at the Brigham and had quite a choice of providers when he signed up. I think, unfortunately, you will have to shop around and find a pcp from the list they provide, instead of the one you want. I know the benefits he gets are quite good; everything except dental.
He works for a small company with 7 employees, so the state option was great for him. He had been paying for fairly reasonable private insurance, but this is a little cheaper. It is too bad that the practitioner you want to go to only takes the free care option people...
I know some think our state mandated insurance is "bad" or expensive, but for my son, it has only been positive.

The plan itself (I have Neighborhood Health) seems decent enough. I did choose a PCP from the list provided, only to find out today that the large practice she is in is currently not accepting new patients (other than the aforementioned exceptions). Seems to me they need to update their list more often. And I don't get why this practice isn't accepting new insured patients but yet is accepting patients with free care/health safety net. It seems backwards that those with insurance have less access than those who do not. Hopefully I can find another provider within a reasonable distance--with the primary care shortage, who knows? I guess if I can't get in somewhere in time to get a physical for school, I will have to have it done at the free clinic where I volunteer--how awkward!!

[Flur]

Shooting Star - I'm in the US and spent about six months working for a health insurance company, and I can tell you that from what I saw, "healthcare" in the US has nothing to do with health or care. The drug companies have control of the prescription industry and literally determine what the insurance companies will cover, the insurance companies have undue influence on doctors and what tests and treatments they will prescribe, and no one at all is thinking about the impact on the patients, not even the doctors. And all these people will tell you their hands are tied.

So, for me, the short answer is no - I don't think the system can be fixed piece by piece. It'd be nice, but I feel like it's too big of tangled mess for that. I have a feeling that no matter what solution our government comes up with, it's going to make things worse before it makes them better.

[Deborajen]

From the doctors' office side, first, I'll bite my tongue on national healthcare. I don't want to get started!

Jolt, I understand your frustration in not getting a doctor to take you as a new patient. Been there! As far as the practice only accepting financially needy patients, it's quite possible that they have an agreement to accept x number of needy patients and they still haven't met this requirement and they're otherwise full. But I'd definitely mention to your insurance that you were just turned down by a PCP on their list. Since you can't get healthcare without a PCP, you're not getting what you're paying for until you get one so their helping you with this would be the right thing. Good luck!

[Flybye]

Doesn't that sound like something straight out of an episode of Seinfeld?

That is exactly what I was thinking.
That is the most ridiculous thing that I have ever heard of.

[BikeDutchess]

There was an article in our local paper this morning about this: Health care reform: Influx of newly insured may overwhelm Utah docs (http://www.sltrib.com/news/ci_12984598). The situation in Massachusetts was noted:


..in Boston, people wait longer than those in other major metropolitan areas to be seen by a doctor. [...] And this is in Massachusetts, the report points out, which has the highest physician-to-population ratio of any state in the U.S. "I think that [Massachusetts] is a pretty good laboratory for what we'd see in the nation if we were to move to some sort of national health care reform," [David] Squire [executive director of the Utah Medical Education Council (UMEC)] said.

I don't think that is a reason to stop trying to reform the system. But I do agree it's going to be very, very difficult. I've worked for an insurance company for 15 years and my DH works for a health care provider. I don't think there is any single party to this mess that can be labeled the "bad guy", but there are many pieces to the system that contribute to its current dysfunctional state.