Tuesday, September 8, 2009

Health care Systems in Europe

It is down  to 'crunch time'. The media are calling this the biggest speech of President Obama's first year in office.  The media thrives on playing off Republicans vs. Democrats, Left vs. Right.

We physicians are cynics when it comes to government and bureaucracy.  We like to get down and 'dirty' and see and treat with minimal interruption, minimize record keeping, and other paperwork.   Let's be real....for every patient encounter..ten minutes of recording data or notes adds up to several hours/day.

Will EMR improve efficiency?  Perhaps it will if someone other than the physician enters the data.  At 200 dollars/ physician  hour in productivity assigning this responsibility is both foolish, and not cost effective.  How many secretaries earn two hundred dollar/hour?

Physicians are a 'hard sell', by the very nature of our training, we observe, gather facts, study, analyze and render opinions, and diagnoses. 

Most of us have had the privelege and ability to chose the type of organization in which we practice and see patients.  Whether it is a group, large integrated healthcare organization or solo practice, we have had the ability to chose.

This weekend from September 10th through September 13th a number of physician groups will travel to Washington, D.C. to  meet with their representatives.  No doubt the media will be there as well.

Our angst will be shared with the unemployed, foreclosed, and uinsured, amidst a sea-change in credit markets, corporate mergers, federal bailouts of banks, financial markets, and underwriting the automobile industry, once the golden measure of American success .

Our government borrows money for many reasons...to fight wars, to fund large building projects, for operational expenses of the pentagon and many other government activities, NASA included.

Many of these activities are accomplished at the expense of healthcare. What are our priorities? 

This does not seem to be a prudent  time to make another revolutionary change in a segment of our economy which now represents 16% of the GDP. 

Most of us patients, and providers alike see access as a problem both in terms of availablilty and affordability, as well as predatoroy insurance company practices.

We need to plug the holes in our system.  There are many other health systems that do just this.  Universal payor is not synonymous with socialized medicine, despite what the AMA and some physicians state.

T.R. Reid points out the strengths of the systems in France, and Switzerland, which provides guarranteed health care for all citizens. 

Depending on the way of financing there are 4 healthcare models

Health Care Systems - Four Basic Models

“Semashko” model – state monopoly

“Bismark” model –social health insurance system

“Beverage” model – a combination of National Health Service and health insurance

“Kennedy” model – also a mixed system, with private structures prevailing in both healthcare and health insurance.



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