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The Doctor Will See You Now ... So Pay Up!

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I ran across a recent piece in Medical Economics that looked at ways primary care doctors can provide their services to the public with less need for administrative services related to insurance. It got me thinking and wondering what you think.

Maintaining a staff of workers to bill the multitude of insurance companies that come into a practice along with the patients is no small -- or cheap -- endeavor. According to the Kaiser Family Foundation, at least 7 percent of health care expenditures in America in 2008 were administrative costs. These expenses include billing. So out of $2.3 trillion in health care expenditures that year, administrative costs accounted for at least $161 billion. That's an enormous portion of our health-care resources that isn't setting broken bones, treating diseases or giving vaccines.

You can't cut out administrative costs completely, but you can tame them (according to the Kaiser folks, less than 2 percent of Medicare's costs are for administration).

As a result, in coming years you're going to see more efforts to establish a shorter and more direct route for money to travel between patients and doctors. Some of the options in the Medical Economics story include cash-only practices and practices that see patients for a monthly fee.

Another approach, which I found particularly interesting, was paying primary care doctors for the amount of time they spend with you. After all, primary care doctors are similar to lawyers and accountants in that they're performing tasks that require skill, judgment and training (but not typically procedures, like a surgeon would do).

People understand that lawyers charge for their time, and that this time generally comes at a substantial cost. They may not be happy about the bill, but when it's time to pay up, most people will readily pull out their checkbook or credit card. Why should seeing a doctor be any different? Why exactly do we have this gigantic, multi-tentacled insurance entity involved in the transaction?

The story I read talks about a family practice group in Virginia, where patients pay for the amount of time they need with the doctor, just as if they were seeing a lawyer. If you need an hour, it's $400. A quick phone call with the doctor costs less, but still costs. According to the story, most of the patients in the practice spend less than $350 a year for all their customary health needs.

Would Americans be comfortable with this type of arrangement if it became more commonplace? Would it come as a jolt to have to see your doctor as a businessperson as well as a healer each time you visited? Is it somehow unnerving to be exposed to the true costs of health care, without the buffer of an insurance company between you and the doctor?

As time goes on, and the way we pay for our health care evolves, I suspect the public will need to answer these types of questions.