Lifelong Health by Dr. David Lipschitz

A new Gallup poll shows that only 44 percent of Americans receive healthcare insurance through their employers. And those who do are paying more than they used to — with greater deductibles and co-payments.

This reflects a 5 percent decrease in insured employees in the past three years. Information from the Kaiser Family Foundation indicates that there are now 44 million uninsured adults and another 22 million below age 65 receiving Medicaid and other public assistance for low-income families.

Doctor visits among those with insurance are declining, as are laboratory tests, prescriptions and medical procedures. Visits are decreasing because of the number of uninsured and also because more individuals have bought health care insurance with high deductibles. Many are choosing not to undergo elective procedures, such as knee replacements, perhaps because of the weak economy and steep co-payments. Patients with illnesses wait later and later to see the doctor, leading to more difficult problems and a higher need for hospitalization.

The decrease in visits has also been noted among the Medicare population. Even a modest increase in co-payments is accompanied by a greater reluctance to visit the doctor. A recent article in the New England Journal of Medicine examined the medical usage of 900,000 Medicare recipients in managed Medicare plans between 2001-2006. During that time, primary care co-payments increased from $7 to $14 and from $12 to $22 for visits to specialists. In 2011, the co-payments are much higher. For every plan that raised co-payments, the number of doctor visits decreased by 20 for every 100 enrollees.

At first blush, these findings seem positive, as higher co-payments may result in unnecessary appointments for minor problems. Sadly, this was not the case. Fewer doctor visits led to an additional two hospitalizations for every 100 patients and an average of 13 more days spent in the hospital. The conclusion of this research was that raising co-payments resulted in sicker patients, more hospitalizations and greater costs.

As patients are waiting to become sicker before seeing the doctor, a new study from the Commonwealth Fund confirmed that as a nation we spend much more on health care than any other country, but outcomes are not as good, care is slower and poorly coordinated.

In their report, 42 percent of patients reported seeing multiple physicians, having duplicate tests, not receiving the care they needed, being prescribed incorrect medications and receiving virtually no explanation of their problems. And they were concerned to learn that their doctors rarely communicated with each other.

Compared with Australia, Canada, France, Germany, New Zealand, Scandinavia and the United Kingdom, American patients were four times more likely to forgo care, skip physician visits or not fill prescriptions because of out-of-pocket costs.

The clear difference between health care in the United States and in other developed countries is the level of coordination of care by primary care physicians. In other developed countries, visits to these doctors are usually free and appointments are readily available. Unlike in America, the primary care doctor, who refers patients to specialists when needed, coordinates all patient care.

This form of care is referred to as the "medical home" and attempts are under way in the United States to duplicate it. The Commonwealth Fund reported that medical homes had lower rates of medical errors, better communication with patients, avoidance of unnecessary tests and fewer emergency visits.

Virtually every insurance plan in the United States acknowledges with pride that their enrollees do not need a referral to see a specialist. And one specialist can refer to another, leaving the primary physician out of the loop. In the future, this mind-set has to change and everyone needs to understand that multiple physicians leads to too many tests, too many drugs and too many procedures that, in turn, result in poor care with an increased risk of mistakes, complications and needless expense.

Policy makers, medical schools, states and the federal government must do more to encourage young physicians to enter primary care. And consumers must work hard to find a physician they trust who assumes the management of all their medical problems and only see a specialist when needed. This is the only hope for solving our totally dysfunctional, bloated and expensive health care system.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at:

www.drdavidhealth.com

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