An essay in the NY times explains how terrible life is for doctors. Reimbursement is down, more time is spent arguing with managed care companies, there are more restrictions on the what they can prescribe, etc, etc.
Now I understand that primary care is in crisis, but overall physicians' salaries in the last couple of years have gone up, and the first doctor in the article is a cardiologist. Cardiologists, as this salary survey suggests, tend to make more than double what a primary care doc gets. And of course, fewer doctors are primary care only now, and more are specialists (who make more money!). But whether or not physicians are getting paid less than they were, their perception surely is that that's the case.
I am surprised that the burden of operating a practice and the demands of "managed care" are felt to have increased. Most observers would suggest that insurers have, since the days of Len Abramson & US Healthcare in the 1990s, backed off the extremes of medical micro-management. In fact, the most profitable health plan of recent years (Aetna) has bent over backwards to appear to be physician friendly. Whether or not it's just window dressing is less certain.
If a doc living in the 1970s was forced into a 1990s world, I would understand the depression. And the surveys I was part of in the 90s indeed showed dismay at what was happening for them. But we're now more than 10 years on from those times, and (as the politicians say) is it really worse now than it was four or five years ago?
June 02, 2008
Buried in a quick notice in Business Week was this paragraph:
Health insurance companies have plenty of critics. Now they have one more: Leemore Dafny, an assistant professor at Northwestern University's Kellogg School of Management. Insurers argue that because they compete against one another, they keep prices down, saving everyone money. Not necessarily, says Dafny in a March paper, "Are Health Insurance Markets Competitive?" Dafny looked at data from 1998 to 2005, provided to her by a benefits consulting firm, that tracked the behavior of 200 major companies to see whether they shopped around to find the cheapest insurers. Dafny found that when these big companies made more money, their insurance providers raised their premiums. But instead of dropping the carrier to get a better deal, Dafny writes, companies generally stuck with their health insurers and paid more. "Carriers can and do take advantage of a firm's increased profits and extract higher prices from them," she says.Here's how this works:
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