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What US are we talking about here? iPhones do not come with specialists already entered into their Contacts lists. GP's have and maintain those sorts of lists. People go to their GP's or to clinics with their problems. If second-trier care is called for, those gate-keeper people will do a referral to a specialist. Many specialists only accept patients on a referral basis because they do not want to deal with a walk-in triage practice. They want prospective patients to have been seen already by someone who can and has rationally sorted them into a particular and more precise professional queue. As for insurance, the 30% or so of the market that is HMO will have set procedures for doing referrals that extend the role and control of the front-line GP into on-going care. In the much larger rest of the market, referrals are also the norm, but the entire process is much less constrained and pre-defined.
As a postscript for those having not kept up with health care decentralization, there was a sharp lull in hospital expansion after 2010 as real and fabricated concerns over PPACA sorted themselves out. As events of 2012 came and went, the process restarted, but with far greater emphasis on out-patient and ambulatory care facilities. Today, about 70% of all surgeries are performed in such facilities, and the numbers of strip mall and pharmacy-based walk-in clinics have exploded.
What US are we talking about here? iPhones do not come with specialists already entered into their Contacts lists. GP's have and maintain those sorts of lists. People go to their GP's or to clinics with their problems. If second-trier care is called for, those gate-keeper people will do a referral to a specialist. Many specialists only accept patients on a referral basis because they do not want to deal with a walk-in triage practice. They want prospective patients to have been seen already by someone who can and has rationally sorted them into a particular and more precise professional queue. As for insurance, the 30% or so of the market that is HMO will have set procedures for doing referrals that extend the role and control of the front-line GP into on-going care. In the much larger rest of the market, referrals are also the norm, but the entire process is much less constrained and pre-defined.
As a postscript for those having not kept up with health care decentralization, there was a sharp lull in hospital expansion after 2010 as real and fabricated concerns over PPACA sorted themselves out. As events of 2012 came and went, the process restarted, but with far greater emphasis on out-patient and ambulatory care facilities. Today, about 70% of all surgeries are performed in such facilities, and the numbers of strip mall and pharmacy-based walk-in clinics have exploded.
You know, you do seem to have a lot of facts but you rarely provide documentation. I worked in a pediatrician's office, GP for kids. I know quite a bit about how the system works.
Many insurances require a referral. I just dealt with this with a friend who broke her arm 4 weeks ago, went to the ER, and only a couple days ago finally saw an ortho. Part of the delay was due to the referral process.
I would like to see some citations for that. Out-patient surgery was pretty common well before the ACA.
4 may seem high to a young, healthy person, but it's quite low to some of the 50+ women I know. And that includes people I've always considered to be healthy.
As with all things, averages can be misleading. It includes people like my mid-60s brother who has not seen a physician since 1977, and and an aging friend with significant health issues whose life revolves around scheduling and attending doctor's appointments.
Most everyday health care services simply do not require the intervention of an actual M.D.
So, you have an MD in addition to being a PhD Economist who dines at The Fed?
You know, constant hyperbole doesn't give you credibility.
Quote:
Originally Posted by Pub-911
Obamacare pushes for decentralization of health care and for relying more on the talents of everyone from licensed nurse practitioners to pharmacists. Isn't that awful?
Too bad no one bothered to tell the FDA, an agency infested with correct-think employment-for-life progressives.
The bureaucrats at the FDA, which regulate everything down to and including the color of the ink and its saturation used on the box the medicine comes in, agree the medicine is safe and effective -- it has already passed clinical trials and numerous follow-up studies.
The FDA even reluctantly agreed a man can self-diagnose if he has trouble getting a woody, although the bureaucrats were even skeptical of this.
MDs even agree it should be OTC. None of this seems to matter to the FDA.
Government bureaucrats require that the prescribing information -- all 29 pages of it -- must be written so as to be understandable by the lowest common denominator high school drop-out. Not the short patient information -- but the entire prescribing information.
29 pages of this, says the FDA, must be re-written so the typical guy who cannot figure out how to file his 1040 EZ can understand the prescribing information.
Even MDs agree it should be OTC. Taping of doctor-patient interaction shows patients never make an appointment to see a doctor specifically for ED. They make an appointment for something else, and as the doctor is leaving the exam room, the patient says, "...Oh by the way, can I have an Rx for Cialis?" and the doctor, late for his next exam, says "Sure. Here you go." "Any side effects I should worry about?" "Nah. Its safe and effective."
Well, I worked in a doctor's office for 11 years, so I saw more than just my own personal issues. The second bold is a talking point I've heard before but have not seen any evidence of. To go back to the personal, when my husband broke his foot, the ER gave him a disc with his X-rays and told him to take them with to the orthopedist's office. X-rays might be redone if the doctor wants to see a slightly different area of the bone, or if it has been some time since the previous ones were taken.
I posted a link with info about too many x-rays, and I could cite an article specifically about dental x-rays (the one type where patients often end up paying their idea of a lot). Here's an interesting one about x-rays in the ICU - https://www.sciencedaily.com/release...1028114834.htm Thanks to discs and better coordination between providers, duplication might not be as big a problem as it used to be. I'll be darned about "if the doctor wants to see a slightly different area of the bone" - it's a valid reason, but if that was the rationale in care I've received, no doctor explained that to me.
Last edited by goodheathen; 11-20-2016 at 02:13 PM..
Thanks to discs and better coordination between providers, duplication might not be as big a problem as it used to be.
This was another push from Obamacare. We're nowhere near done with all this yet, but having portable and accessible digital records contributes both to better care and to lower costs.
Quote:
Originally Posted by goodheathen
I'll be darned about "if the doctor wants to see a slightly different area of the bone" - it's a valid reason, but if that was the rationale in care I've received, no doctor explained that to me.
Doctors do tend to explain what they want to do and why. This amounts to more than just "bedside manner."
Just presenting the facts. If they pique your curiosity, do go off and delve into them further.
I am virtually certain I know more about this issue than you do.
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