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Preventive care coordination problems

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I summoned up the energy to try to get some ordinary preventive care through a new health plan recently, and my observation is: Getting even the simplest kind of preventive care is way too complicated.

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Years ago, ordinary family doctors typically did everything to do with checkups themselves. They would have handled all of the simple aspects of looking after a whole patient.

Then, the doctors overtreated, overcharged, bought yachts and started the reimbursement war we have today. The current landscape: Doctors complain about the nasty, stupid insurance companies, and the insurance companies produce stacks of printouts about fraudulent claims.

Thanks to that tug of war, insurers discouraged doctors from referring patients to their own testing and radiology facilities. Providers have also tended to split off those sorts of tasks because of pressure for efficiency, the high cost of modern testing equipment, and increased provider specialization.

The result: I went in for one ordinary primary care checkup and ended up with referrals for at least three tests I ought to get, from three different facilities. The doctor turned out to be interested in treating only part of my body, so I have to go find another doctor to treat the rest of my body, and I’m pretty sure that doctor will give me a referral to get at least one other set of tests.

I’m an ordinary person who’s hoping I’m healthy. Even so, I’ll have to go to at least six separate appointments just to get the full set of basic preventive services, which I ought to have to be a responsible citizen.

Some big, hospital-related group medical practices are trying to get around the self-referral restriction problem by setting up “medical malls” in big office buildings.

Improving coordination of care for people with multiple expensive health problems is an important, complicated, well-publicized problem.

It would be nice if encouraging the creation of well-integrated medical malls and other one-stop shopping facilities for getting routine preventive care could also be somewhere on the list of priorities. Pokemon Go is a nice phone app, but I dislike having to go through a Pokemon Go scavenger hunt just to get all of the tests that are supposed to be part of an ordinary, no-frills checkup.


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