This isn't meant to be a rant or political diatribe, rather a point of view from a medical practitioner about our current and potentially future medical world. So here goes..
I work for an institution where a majority of our patients are covered by either Medicare or Medicaid - the federally funded health insurance programs. The rest are either private insurance or self-pay. With that being said, any changes in federal funding or reimbursements have a HUGE impact on our budget, operations, and bottom line. It affects how many new staff can be hired, what kind of benefits can be offered to staff and even what products are available.
There has been a lot of talk recently about federal budget cuts and what programs would be affected. After all, we are in a recession right? And no matter what the analysts say, the country is not exactly bouncing back quickly. This means the government is trimming "the fat" and cutting funding across the board. Well within the last week, it was announced that cuts would be made to Medicare and Medicaid reimbursements. For my institution that relies so heavily on these federal insurance monies to pay for services offered to patients, these "small cuts" can mean hundreds of millions of dollars of losses. That money has to be made up for and that means cuts in the operating budget.
Not a week goes by that I get an e-mail about cost-saving measures or the institution's attempt to balance the budget. It's pretty stressful being the new person in a place that's talking about cost control and hiring freezes. It has been said and said again that they are doing everything they can to prevent lay-offs and luckily I believe them. But it makes me think.
Our government has offered to extend health insurance coverage to millions of uninsured in our country. But when it comes to paying healthcare providers, hospitals, etc they decrease what they are willing to pay. In other words, we are expected to do more (see more patients in an efficient way) with less money while jumping through the seemingly hundred of hoops the government requires in order for them to pay the bills. And private insurers quickly follow federal reimbursement guidelines, which means even less money. Oh, and then I get patient families who ask me to write a prescription for an over-the-counter medication so medicaid will pay for it. Seriously? No, I will not pay for your $4 bottle of tylenol (because, yes, I, as a tax payer will be paying for it). If you can afford your fancy bag and your pretty earrings, you can pay for your child's medications. No, not everything is about a dollar sign. But when it comes to affecting how patients are cared for, it becomes an issue. Have I seen things that affect quality patient care? No, not yet. But it worries me because eventually something has to give, right?
Do I have a solution? Unfortunately, no. I'm not sure anyone has the cure-all. But there's got to be something better than the status quo. I don't know.
Okay, now I'm off my soapbox.