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From: km@cadre.UUCP
Newsgroups: net.flame
Subject: Re: People who gouge others for profits
Message-ID: <197@cadre.ARPA>
Date: Wed, 23-Jan-85 12:55:43 EST
Article-I.D.: cadre.197
Posted: Wed Jan 23 12:55:43 1985
Date-Received: Fri, 25-Jan-85 09:29:08 EST
References: <187@abnji.UUCP>
Reply-To: km@cadre.ARPA (Ken Mitchum)
Organization: Decision Systems Lab., Univ. of Pgh.
Lines: 41
Summary: 

I will admit upfront that I am a physician. Also that I am under
40 years old. I am an internist who works for a *salary*. The
preceeding should explain any biases present.

The problem is not as simple as it sounds. While there certainly
are many situations where physicians overcharge and cases where
they legally or otherwise profit from hospital charges, what
appears as the final hospital bill represents many things. While
the vast majority of these represent the result of physician
decisions, hopefully with patient's full consent, the physician
in many cases is ignorant of the magnitude of particular charges
and how they are incurred. I would like to make a few (biased)
points:

1) The major problem is not overcharging, per se, but overutilization
of facilities and procedures. A physician may run many unnecessary
tests because for several reasons unrelated to any profit motive:
   a) he may not understand what is going on with his patient so
he is trying to cover everything possible.
   b) he understands quite well what is going on but feels compelled
to prove to the patient that nothing else is going on, either for
fear of malpractice suits, or because the patient demands it.

2) Many tests result in patient hospitalization because the procedure
would not be paid for on an outpatient basis. Insurance coverage is
heavily biased towards paying for procedures on inpatients, resulting
in hospitalization which is not medically necessary.

3) Insurance coverage is also heavily weighted towards providing
payment for tests and procedures, rather than history and physical
examination. As a result, physicians are tempted towards learning
and performing tests and procedures, rather than spending the time
and involvement of a proper history and physical examination. In
many cases, spending 45 minutes of time with the patient and doing
a thorough history and physical will result in a correct diagnosis,
or at least narrow it down, so that tests and procedures are done
to confirm what is suspected, and not replace the physician's
thinking.