It should not be necessary to point out that any system of National Health Insurance will ultimately depend on the cooperation of the doctors in this country for its success. The satisfaction and the happiness of the individual physician is important to the quality of health care. I don't think any of you would want to consult a physician who is unhappy in his job. I would submit, in all sincerity, that freedom within the widest possible latitudes in the practice of medical care is an ingredient absolutely essential to the success of any National Health Insurance program. I thank you for the opportunity of testifying before this Committee. Testimony on National Health Insurance by David S. Masland, M.D., President Elect before the Subcommittee on Health I am Dr. David S. Masland, President Elect of the Pennsylvania Medical Society. I am also a board certified internist and for the past twenty years have practiced in the small Pennsylvania town of Carlisle. In speaking to you today, both of these capacities are important. As an officer of a large State Medical Society, I am acquainted with the thoughts and opinions of my colleagues. As a physician with a large private practice I experience daily the problems of our health care system, as well as its many good points. As a physician I am concerned that quality health care be available to everyone. In our group practice my three partners and I see approximately 500 patients every week. This is the greatest number we can see and still provide quality care. I am sure you are all familiar with the 1974 study performed by the Rand Corporation concerning the effects a national health insurance plan would have on our health care delivery system. That study pointed out that an NHI plan offering full coverage without deductibles or co-insurance would generate an increase of 75% in the demand for ambulatory services. In other words, we could expect a 75% increase in the demand for primary care. 58-442 O 75-7 I personally know of no way that my partners and I could expand our practice to accommodate an additional 375 patients and still give quality care. I know of no primary care physician who could accommodate a 75% increase in the number of patient visits. This problem is complicated by the fact that much of this increase would undoubtedly come from the "worried well," people who really are not in need of medical care. To allow such an unnecessary increase in demand would jeopardize the delivery of care to those who really need it. Obviously then, as a primary care physician I am concerned that any national health insurance plan have some type of control over unnecessary demands for increased services. could be in the form of co-insurance. Perhaps this As an example I offer some personal experience in this area. When I first came to Carlisle and established my practice many years ago, for personal and professional reasons, I chose to treat certain persons free. These were not indigent individuals but persons that I felt I should offer care without charge. I found however, that these patients quickly became the most demanding. Their demands for appointments were two to three times greater than those of paying patients. The same held true of their demand for house calls, two to three times greater. In an effort to correct what was fast becoming an uncontrollable situation, found it necessary to institute a partial charge for these patients. This could be compared to the co insurance provision contained in some national health insurance - 3 bills. The result was an almost immediate correcting of the situation. The demand for services by these patients fell to a rate comparable to that of my full paying patients; and I might add with no discernible impact on their health. I very much believe that this same idea of co-insurance would help control the unnecessary demand for services under a national health insurance plan. In any event, the mechanism you decide upon should ensure that the system is not overwhelmed and that quality care is available to those who really need it. My second concern is one that I am sure you have heard before. This is the ever increasing burden of paperwork and red tape. On the surface it may seem trivial, but to the practicing physician, believe me it is not. Currently, only 40% of ambulatory care is covered by insurance. In my practice, that percentage is considerably lower, but the amount of paper work even this small percentage generates is extremely burdensome. It requires many hours of my own and my staff's time; time spent on paper rather than on people. As a matter of fact, within our practice we have found it necessary to hire one full time person to do nothing but fill out forms for third party reimbursement. I do not look forward to the day when a claim form would be required for every patient visit. The amount of paper work we would face could easily triple or quadruple. All this paper work means additional expense to the health care system. The hours spent on paper work are part of overhead expenses which must be covered in my fees. The cost is a substantial one. Already, for example, the current fee paid for a patient visit under Medicaid in Pennsylvania does not cover overhead. In other words, the cost of the visit is greater than the fee allowed for the visit. If you multiply the present paper work cost by the number of physicians in the country you already have a very substantial sum. The danger of a National Health Insurance paper work explosion is a real one. The problem would be worsened if on top of all this we added a federal bureaucracy. Many existing federal programs have already demonstrated their inefficiency. I would contrast this to the Blue Shield and Blue Cross plans in Pennsylvania with their low administrative costs; approximately 10% of the premium dollar. It would seem ill-advised then to transfer the functions now provided efficiently by private carriers to a federal bureaucracy. My third concern, and perhaps the most serious of all, is the eventual impact any national health insurance plan will have I cannot accept every patient who comes to me for treatment-just as some patients cannot accept me as their doctor. It is also human nature that at times two individuals may become incompatible. If this is the case, the patient and the physician must both be free to discontinue the relationship; otherwise the quality of care will suffer greatly. |