Everybody's favorite health care economist, Uwe Reinhardt, sent in a letter to the editor responding to Peter Salgo's New York Times Op-Ed "The Doctor Will See You for Exactly Seven Minutes". Reinhardt takes issue with the blame game:
Dr. Salgo also says that "publicly traded H.M.O.'s, for example, began restricting doctors to an average seven-minute 'encounter' with each customer." I defy him, or any doctor, to produce a memorandum from an H.M.O. to that effect.
During the 1990's, H.M.O.'s did extract discounts from doctors. To keep their income at previous levels, doctors voluntarily shortened visits. The H.M.O.'s were not to blame.
Finally, the average length of hospital stays started declining in the mid-1980's, after Medicare began paying hospitals a flat fee for each admission. Hospitals found it profitable to voluntarily reduce the length of stays.
Another letter echoes part of these sentiments -- that it's not up to patients to enact change, but that doctors need to take more responsibility for the deterioration of the doctor-patient relationship, because they didn't do enough to stop changes in the first place.
With all due respect, Prof. Reinhardt is quibbling.
Clearly managed care (and Medicare) have periodically either cut reimbursement for office visits, or have failed to raise reimbursement to keep up with inflation. Also, they have imposed ever greater bureaucratic burdens on office practitioners that increase their overhead...See this article that shows that primary care physicians' charges (reflective of patient volume) have increased much faster than their compensation, which has failed to keep up with inflation:
For Reinhard to call physicians' responses to managed care and government practices "volunary" is sophistry. Furthermore, I wonder if perhaps Prof Reinhardt's thinking is being influenced by his conflicts of interest?