Trip to the candy store-Not!

05/17/2009 at 5:18 AM Leave a comment

Interesting lessons I have learned about people. It is important to have skin in the game for them to value anything. Free generally comes to mean worthless.

I am the only spanish speaking primary care in  the area and I attract quite a following. These people do have some money but clearly dont have insurance. They are generaly desperate for someone to talk to them about a variety of usually minor ailments. When I started I only had a few a week and I would charge them as the mood struck me. Usually quite low. It was a disaster.

Instead of my getting people that needed help, I started to get people that had nothing better to do. Although we still discount significantly, now the fee is standard for everyone but is not insignificant ($49) and I am back to taking care of the sick.

This same point is specially true for patients with medical assistance. They have no out of pocket expense and there is no problem to small that they will not come to the office for. Or make many appointments and not show up. There is no consequence.  Sometimes they just need to get out of the house, sometimes the parent doesnt want to go to work (she gets a note she was at the doctors office). If you compared the number of visits by a kid on MA versus one that has a copay vs. one that has no coverage the contrast is amazing.

I hope that as the powers that be work on health insurance, that they include skin in the game for everyone. I mean everyone. It does not have to be alot. But I have yet to meet the patient so poor that they could not afford a pack of cigarettes. A $5 copay would not be a barrier for anybody.


Entry filed under: How things work, office workings.

Java, what makes the world go round skin in the game part deux

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