Brad Sallows said:
>First, how do you define routine?
We could beat this around for days and not achieve a concensus. Leave it to the profession. Dentists and dental service insurers seem to have figured out how to calibrate their system.
The intent of my previous post was to point out that savings to the public purse would not be as great as some seem to imagine should individuals be responsible for "routine" or basic health services, however, since the cost of a "routine" visit would be borne by by us whether through public funding, private insurance, or personally, there is significant difference in routine care between the medical world and the dental world.
When I see a dentist for a routine visit, it is very clear what will be done and therefore it is relatively easy to forecast the cost. It is not so easy when someone presents to the medical system, with what may be a routine problem.
I will use a personal example that involves both the American and Canadian system. Several years ago, I was in Northern California (on business, and incidentally it involved a hospital). Having concluded my business activities that day, I was in my hotel when I started feeling particularly unwell. I hadn't been feeling great during the day, either. Among my symptoms was chest tightness and SOB, also there was some aching in my left arm. Though not concerned that I was having an MI, I did feel that I should seek medical advice since I was flying in the morning. The problem, however, was finding a doctor to see me. The hotel wasn't able to provide me with a referral and DIAB (doc in a box) clinics are not common down there as they are here. My only recourse was to visit the emergency dept at a local hospital (not the one where I had been on business). After spending about 2 hours in the waiting room, another hour with the admission (finance) clerk & a screening nurse, an hour sitting in a hallway, I was put into an exam room where I finally met what I first took to be the doctor (turned out he was both nurse practitioner and physician assistant ex US Navy). After my history and a physical exam, he suggested that that an EKG and some blood work was necessary. Techs came in to do these and the NP/PA returned to discuss the EKG with me. He said that he didn't see anything grossly abnormal with it, but he wasn't that great with EKGs and it would officially be read by a doctor. I had a look at it (recalling some of what I remembered from my MA days) and was able to point out a couple of things to him though they were not of any great clinical significance. After having another listen to my chest, he asked me how I felt and then stated he wasn't sure what was wrong with me (also said that he had reviewed my case with the attending doctor in the ER), but that I should take it easy that evening and see my family doctor when I returned home the following day. Before leaving the hospital I managed to get photocopies of all the records that had been generated on me so far and tried to get a bill for the services rendered. I was told that a bill would be sent to me. I knew that it would be more than for comparable service in Canada, but PSHCP (at that time) would cover three times the reimbursement rate from OHIP SOB. This sticker shock is now lessened since PSHCP is now using an emergency travel assistance provider.
The next day I saw my GP who listened to my chest, said I had pneumonia, prescribed an antibiotic, ordered an XRay as a precaution and I started feeling better by the next day.
Now the fun began as I started receiving the bills from my American adventure. By the time they were all in (from the hospital, the ER subcontractor, the ER doctor, the lab/EKG subcontractor) they totaled in excess of $5500(US). Ahh, the free enterprise system at work. As this was somewhat just up my alley, I first checked what would be reimbursed by PSHCP, around $2100(Cdn). By the time negotiations finished with the Americans, I was out of pocket about $100 and they had not "waived" one charge but they were not able to "justify" all.
Two "routine" visits. Both for the same problem. Significant difference in outcome and costs.
PS: The amount that was paid by PSHCP (reimbursed to me) was also significantly lowered.
edited to include the PS