Many practicing physicians are opting out of managed-care plans and Medicare and offering their services to patients on a cash only basis. They're doing it because they feel they can give patients more time and attention. Patients are treated better and feel more comfortable when they get uncrowded waiting rooms and long, uninterrupted office visits from a more courteous staff.
The trend was recounted recently in a front page story in the New York Times, heralding "For Those Who Can Afford It, Old-Style Medicine Returns."
One physician profiled was Herbert Rubin of Beverly Hills, Calif., who has had a cash only policy for two years. One patient, a retired insurance salesman, initially changed doctors because of the policy. However, he soon became disillusioned when he found his new doctor's waiting rooms and exam rooms were always packed and he had about 20 seconds to explain his symptoms before the doctor interrupted him.
Eventually, the salesman returned to Rubin because he felt more comfortable there.
The article characterizes those who are saying goodbye to managed-care plans and sometimes even Medicare as "renegades." My internist here in Chicago is one, although he accepts Medicare patients.
Not surprisingly, this concept disturbs many people who dream of nationalizing the American healthcare system. Anything that smacks of free market forces drives them into a frenzy. And, of course, managed-care plans have to some extent helped to reduce overall healthcare costs. But the wear and tear on patients and the damage to the physician-patient relationship is less than desirable.
So there's a new twist in the delivery of healthcare, one that lets patients decide whether their doctor's service is worth the expense. And it's spreading to include a broad cross-section of specialties, including family practitioners, general surgeons, gastroenterologists, psychiatrists, psychologists and cardiologists.
HMOs and other payers have only themselves to blame for a system marked by frustrated and even insolvent physicians. Now the market is reasserting itself.
Patients get "instant attention, instant service," says Victor Fuchs, an emeritus professor of health economics at Stanford. A huge amount of the dissatisfaction with medical care has to do with the quality of service, he argues.
And Richard Schubert, a fee-for-service internist in Washington, succinctly sums up the development. "It costs patients more money, they have to pay for it out of pocket, they have to decide if they think it's good value for the service," he says. "Maybe you think spending the extra money on a doctor is not important and you'd rather get a BMW. You have to decide how you want to spend your money."
Patients deserve to be treated with dignity and respect. It's about time healthcare catches up with the rest of the world and gives customers what they've been asking for.
It's here to stay,
Charles S. Lauer