A Washington Post piece provides some interesting thoughts on addressing some of our perceived health system problems by rethinking the basic model of how we deliver care. The author, a physician, describes a practice redesign that allowed her to spend more time with patients. (WP Op-Ed) She relates better quality and satisfaction outcomes for herself and her patients. A number of physicians have explored various practice reconfigurations, often avoiding acceptance of insurance payments along the way. Sometimes it appears that if left alone by lawmakers and regulators, the system might find ways to heal itself. The prevalence of third-party payment has undoubtedly added both administrative costs and delivery of unnecessary services to optimize revenue. Having as many patients as possible pay for as much care as possible directly would correct some of the warped incentives in our current system.
The piece also points out another major issue with our system–it forces physicians to do much of the work that could be done by other professionals. The author refers to Swedish models where physicians see only the small percentage of patients who really need the expertise of a physician. Doctors in the US are to blame for this situation; they have repeatedly sought to limit the scope of practice of other professionals. Addressing these restrictions could ensure that there is adequate physician capacity for when it is truly needed and significantly lower costs.