Are Doctor's Offices Going the Way of Mom and Pop Stores?
I recently came across this very interesting article in the New York Times about how many companies are now creating on-site medical facilities for their employees. Once thought to be redundant and not cost-effective, corporations such as Toyota, Pepsi and Sprint Nextel are now offering their workers medical care such as "check-ups, allergy and flu shots, pregnancy tests or routine monitoring for chronic diseases like diabetes and asthma."
The employers insist that there is a "firewall" of confidentiality between clinic records and the company, but I am skeptical. While it is doubtless a sign of good management to keep your employees healthy, isn't there a temptation to control the bottom line and perhaps weed out people who aren't with the program?
In other words, doesn't it make sense to keep the company you work for and the doctor you see separate? Isn't your health a personal responsibility and not a business obligation?
I also wonder if the mentality that is used to operate these clinics has the best interests of the patient in mind. After all, they are directly beholden to the company which operates them. Can they maintain the rigor and objectivity of a private practice? Will the quality of care suffer because medicine isn't the main priority?
Still, it's hard to deny the lure of these onsite practices, especially since they are so convenient to the patient. It takes less time out of their work day, and many companies have fully stocked pharmacies, so it's like one-stop shopping.
Finding a physician, making and keeping doctor appointments, or just living a healthy lifestyle all require some degree of effort. Making those choices easier isn't necessarily a bad thing, but we must be careful about such things as the erosion of employer to employee regarding medical care. There may come a time when having a pre-existing condition or a bad personal habit will prevent you from getting employment, as well as the treatment you may need.
posted by Anne @ 7:01 AM
13 comments
13 Comments:
Somehow verybody in this country seems to forget that the employer is paying for this health care/insurance. It is not a God given right or even a constutional right for anybody to have free (or paid by somebody else) health care anywhere they want or from whom ever they want. In this country you can go to most any doctor and open your wallet and he will see you. It might be expensive but so are Lexuses. Not everybody drives one and not everybody has box seats to the superbowl. The employere has a right to offer the service in the way they see fit, you have the right to go work some where else. It's America and were free to do as we please. I applaued companies for providing convient healthcare while holding down the cost of their product so maybe more people can drive Lexuses. Free enterprise-it's the American way.
Free enterprise used to be the American way but no more. Only corporate giants can offer this kind of a benefit. There are no longer very many business that can afford any kind of insurance coverage to their employees. When did we become so indifferent to the well being of others? We are a country "for the people,and by the people" and having deceit healthcare should be available to everyone. The insurance industy has become way too powerful. Our government has neglected their people too long and has spent billions in other countries. They do it for personal or professional gain and we the people are left hanging.
This subject reflects two trends. First, employers are naturally taking a greater role in trying to influence the health status of their employees simply as a result of trying to manage their rising health care costs. Since the workplace is becomming the nuclear family in our society, this is expected and not altogether bad if we are to being to reverse the many negative health trends occuring in the U.S.
Second, this also represents an expansion of the "continuum of care" beyond the traditional provider network. Especially primary care services are morphing into a variety of new models including "retail" screening centers, corporate health centers, alternative medicine, etc... Again, this is not a bad thing if it means that more people have easier and less expensive access to care.
As health data becomes electronic and is more easily accessible to providers, where you get care may be less relevant versus getting it at all.
I truly believe that the employers are doing their best to cut down on the time it takes for an employee to see a physician and missed work for such appointments. Not a bad agenda at all. I also believe it is an effort to defray the high cost of insuring their employees. A win win situation. However, if the physicians performing the services cannot remain objective in the process then you have another side of the story. Working for physicians myself, I sometimes see that the doctors choose to treat their employees a little differently. Especially, when it comes to time off needed for conditions. Where they might strictly instruct another patient to be on bed rest for 2 weeks, they will tell an employee/patient you need to be on bed rest 1/2 a day for the next 2 weeks.
The physicians that work for large corporations will always have to keep in mind that they are taking care of patients and not directing care as mandated by the best interest of the Corporation.
The one part of this puzzle nobody has mentioned is the decline in medical school enrollments...the number of physicians who are choosing early retirement rather than working to make the insurance companies richer or to pay higher and higher malpractice rates. The brightest and best are choosing other professions, and who could blame them. I worry that as the population ages there will be fewer and fewer doctors who will participate with Medicare or private plans. Only the wealthy will be able to afford routine medical care. In addition where are the medical school teachers going to come from? What about research? These giant companies will hire the best docs, pay them a huge salary. The others physicians will continue to fight rising costs and flat or declining reimbursements. What other profession has its income capped by outsiders? When our costs increase, we cannnot pass the increases to our patients. Our system, which has always been the best is broken. Until we realize that physicians will not continue to be bullied, the medical profession as we know it will cease to exist.
Interesting. I think the weakness in the article is the fact that
people, including healthcare providers, work according to the incentive
system. A group of doctors that owns a clinic has a lot more validity to
work hard than someone that is a staff physician for an HMO, a company
employee staff physician, or a hospital owned clinic practice. Where are
the incentives for seeing more patients, seeing them more efficiently,
and trying to provide the highest level of care? Follow the dollar, if
it is easier to prescribe and fly, why would a provider do more than the
minimum. Although I wish human nature was different than it is (i.e.
more altruistic) capitalism works because it is built around self
interest. Adam Smith would argue vehemently against this article I would
have to agree with him.
Having an employer provide medical care has been happening for years in
the military. As you pointed out the challenge of keeping the
information private and out of employers hand is a challenge. HIPAA is
supposed to ensure confidentiality for the employee. If a physician or
employer crosses this line then there are fines and a potential for law
suits.
This could work, but the employer has to understand the employee's
rights. From an administrative side this could have some interesting
value too. If you have a large company that is associated to small
branches they could all benefit from the service. Most likely the
employee's will still have health care coverage. The company could
still bill insurance for cost and possibly generate additional revenue.
Employee's could payroll deduct their cost ensuring a reduced AR.
2 points I would like to make:
1. print the article and show it to 10 "line" employees. I bet the reaction you get is that they would love to have the same benefit.
2. someone mentioned that these clinics will be less efficient w/o the incentive to see more patients. That depends on how they are compensated. They will also be less like to order unnecessary testing running up the cost of medical care delivered.
Good article but you're kidding if you think people
want responsibility for their health care. They want
someone else to take care of them--either big
government or big business or anyone. The want no
responsibility for their choices or actions/inactions.
I suspect we'll get England style health care before
long--with those who can afford it going to other
countries for complex procedures. The masses will
just wait in line or be provided paid meds until they
just die. And, yes, that is what is provided in
England unless you have the money to buy different
care. Canadians just come to the US.
A couple of thoughts...Some large manufacturing companies already have MDs on staff to handle the work related instances (one example is GM plant in Arlington). I don't see this as something new but rather a continuation of something already offered.
Consider this, why would an MD want the hassle of taking call and trying to see X number of patients per day to make ends meet in the office and deal with the headaches of HR. It seems very attractive to earn a salary that is not dependent upon what Medicare does, while keeping a very robust work/home balance.
A very interesting article. I am sure there is some benefit to large companies with this sort of arrangement for health care. I am not sure about the continuity of care however, for these employees. Do they still need a "regular" physician? Who do they call on weekends and at night? I would expect the ER visits to go up for a group like this when they have nobody to call on off hours. This system only addresses the smaller portion of the health care expenditure, outpatient, but doesn't do anything about the higher dollar costs of inpatient care. What about the physicians in the communities where these clinics operate? Are they left to take care of the seriously and chronically ill, which can cause financial problems for them? Or will they be left with Medicare and Medicaid and indigent care, and will you start seeing even less primary care access in these areas? My sense is that the health care pie is limited in size and this is just another slice that takes away from the whole, similar to all the other health care "schemes" that have occurred over the last 20 or so years e.g. utilization review companies, case managment companies, second opinions, all things that have outlived their usefulness. I'm not sure what the answer is.
I just found the time to read your interesting articles. As an employer
of over 120 employees and a sick problem, I would love to have a clinic
on site however as an employee I want my health to be confidential and
not shared with my employer unless I want to. Also the confidentiality
of employees to other employees would be a concern as well. Good
thought process but not a viable option for most employers (Cost
prohibitive is another reason not to do it)
I agree that the employers pay the lion's share of the health insurance costs but I do believe that many employers will misuse the information that they have on employees. I have seen already in my career that companies that self insure already have problem around how they manage the privacy of employee health data. I agree that costs should be driven down but the employers can do that by driving a harder bargin with the the insurance companies.
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