Wednesday, July 23, 2008

healthcare costs

Yesterday, I saw two patients and received a phone call about a third one with mosquito bites. No fever, no pain, just itching, no concern for WNV. The parents wanted me to fix the problem. I was a little bit confused about how to fix it, as I am not an exterminator. I recommended kid-safe bug repellent and topical vinegar for the itching. Recently, I had a pre-teen come in with a pimple on her face. One pimple. I saw another child who had sneezed a few times, really. But doc, she doesn't usually sneeze. Of course, I can come up with zebras that these problems may hide as. I also know I am not alone in seeing such patients. But something all of these patients have in common, and I could give many more examples, is that they do not have co-pays for office visits, they have medicaid. Our taxes pay for me to see the 11 year old with the pimple. At least she didn't go to the emergency room.

I may be crucified for saying this, but I really believe that all patients should have to pay a co-pay, even if it's only 2 or 3 dollars (less than a pack of cigs or a bucket of soda from the local convenience store). Perhaps this will make some people stop for a few seconds and consider if their child really has a problem that needs to be addressed by a physician. A two dollar co-pay is still a bargain, and certainly less than people with private health insurance have to pay. Our health-care costs in the USA are spiralling out of control, and we are not doing much to address this problem. These small co-pays could perhaps help, even just a little, with reducing our costs, and these days, every little bit helps. Such visits are a waste of time, money, paper, and gas for the family to get to the office! I know that what I think is scary may not be scary to parents and vice versa, but really. Mosquito bites, zits, a few sneezes, a fleeting moment of achiness, I say YARRRGGGHHHH (but I can't say that to my patients!).


Dr. Roberto said...

I'm a pediatrician from Tijuana B.C. Mexico, and I just found your blog through the AAP website.
I'm 20 years into pediatric practice and just feeling frustrated by the same problems as you describe in your blog.
I leave the Hospital practice about 10 years ago because my private practice was very good (and more rewarding in the economical aspect).
But the situation has changed in the last years (more in the two last years) there are economical variables, that are out of my reach and suddenly everything is down.
This has been the most sad summer in my 20 years as a pediatrician.
Hope everything turns around in the next months or maybe I just have lo leave the practice and do something else. It's very sad.
Hang in there, even if you have this inconsecuential patients.
I feel that I'm using only 3% of what I learned in Pediatric residency.
After reading your blog I feel that I'm not alone with this feelings.
PD. I feel the same about the music as you.


Roberto Ramirez-Avila MD

Alex Cvijanovich said...

Muchas gracias, Dr. Roberto! I am sad to hear that you have these same concerns in Mexico as well, although I am not surprised. Medicine is constantly changing, and it will be interesting to see where we end up in 20 years. I think that as the American economy continues to go down, we will see effects worldwide, now that we have such a global economy. And, of course, you will definitely feel the repercussions of American border policies, as they evolve over the next few years.
I hope you find some peace in your practice!