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How you control Health Care costs, by putting patients at

by Ziks511 / October 19, 2012 10:07 PM PDT

risk.
In the Province of Ontario, the "Liberal" government has passed legislation whereby tests which yield normal results are charged to the Doctor who ordered them.

So, how do you assess a patient who has a problem which may have one of several causes. Do you write him up for the 3 or 4 tests whether blood or X-Ray, or MRI which would identify the problem, knowing that all but one of them will be charged back to you as the Doctor?

This is a result of the Federal Government under Ronnie Raygun's good friend Brian Mulroney backing out of its legislated part of the original Health Care Legislation in the early 1960's. Originally it was 50-50 Federal Provincial. Now it is all Provincial, with no Federal money at all.

Canada's Health Care System costs between 66% and 75% of that in the US before Obamacare came into effect, longevity here is longer, infant mortality is lower, and litigation is very low. Generally health in Canada is comparable with that in all the countries which offer a centrally administered single payer system, viz. Europe and Japan.

Oh, and 100% of Canadian residents are covered, which was not true of the old or the new US Health Care systems.

Personally I would like to see all taxes on cigarettes and alcohol funnelled (sic) into Health Care, the way gasoline taxes are used here for road and Highway maintenance.

Rob

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How about, to keep hypochondriacs from taking away
by Steven Haninger / October 19, 2012 10:24 PM PDT

time from truly sick patients, making them pay the uninsured rate. I don't know how a doctor can be expected diagnose and treat without ruling out suspected causes. This means that not all tests will come back positive. Sounds like a dumb idea to have the government dictate what physicians can do. Unless the doctor has an in-house screening laboratory, they don't make a dime on laboratory testing. Kickbacks are not legal.

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There have been other instances here too. Call an ambulance
by Ziks511 / October 20, 2012 12:45 AM PDT

for something not deemed an emergency, and you get charged for the Ambulance trip. The evaluation is made by the Emergency Room Physician, and entered on the Ambulance form.

Rob

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what is an "hypochondriac"
by James Denison / October 20, 2012 2:59 AM PDT

Sometimes it's a person with nothing wrong other than his belief. Other times it's someone with a health problem the doctor can't diagnose, but the problem nevertheless exists.

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Exactly right
by Steven Haninger / October 20, 2012 3:03 AM PDT

and a doctor who doesn't know this is forced to continue looking. This means more and more testing. The doctor will see lawyers to the left and lawyers to the right of him no matter what. Should he eat the charges for tests that come back negative or risk a lawsuit if he dismisses the "sick" person?

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Ego enters at that point
by James Denison / October 20, 2012 3:08 AM PDT
In reply to: Exactly right

"If I can't find it, then it's not there, so it's easier to label this person a hypochondriac".

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Which, infortunately,
by TONI H / October 20, 2012 6:11 PM PDT

is what was happening with women and heart attacks.....symptoms present differently for women, doctors didn't realize it, and most times the woman would die before it was realized. Or in my first husband's case, a brain tumor that kept shifting but seizures kept coming from 1972 to 1977 when he went blind for no reason driving home from work because he hit a pothole. Sight came back just in time to avoid a collision, 'crippled' his way home, got to a hospital, and some really sharp ER doc spotted the pressure behind his eye before it went away and 'hid' again. Tumor found but it was too late to save his life now. He was a VietNam vet when PTSD was just coming into the light and he was told over and over that it was 'all in his head'......turned out, it literally was......because various doctors and tests for five years never revealed what it was.

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Don't get fixated on that word
by Steven Haninger / October 20, 2012 7:48 PM PDT

It's a label that has been abused in some cases but not in others. Persons who are consistent in their complaints are probably the ones more likely to have real hidden issues. Those whose pain or symptoms move throughout their bodies and vary with each visit probably have some mental disorder or desire for attention. There may be no cure for that. I suspect doctors know this happens but are powerless to blow them off for fear of potential legal issues should be be wrong just one time.

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Kickbacks may not be legal
by Roger NC / October 21, 2012 1:42 AM PDT

but I'm not sure there is a less direct feedback some how. Can a doctor own stock in a particular corporation that specializes in health diagnoses and monitoring.

I know that's cynical, but I generally trust the doctors I see.

Actually the front line, general practiioners don't arouse my cynicism as much as some of the specialist and/or alternative care clinics.

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There were abuses long ago
by Steven Haninger / October 21, 2012 4:49 AM PDT

Doctors practices could have their own small laboratories with nurses and other untrained personnel running the equipment. Laboratory testing services make much more money than time with the doctor. This was heavily abused by doctors who saw Medicare patients. CLIA regulations put quite a number of those operations out of business. When I was working, I was a witness to the shoddy quality control practices in quite a number of these places. Some doctors such as oncologists need some on site testing in order to manage chemotherapy treatments. They now need to hire qualified people to operate and maintain laboratory instruments. They must keep good records and are regularly inspected for compliance. This eats greatly into the profits some would reap when no one was overseeing this.

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not related to kickbacks
by Roger NC / October 21, 2012 5:03 AM PDT

but what I hated was for a while I couldn't get blood work done at the center shared by my doctor's group practice and hospital, I think it was run by the hospital, because of insurance squabbles. It often meant two different days making a 2 hour round trip plus office time to get the blood work the doctor ordered. Before and after about a year disagreement, I could get blood work done within walking distance of my doctor office and with normally only a short wait.

And why do blood drawing and testing clinics have banker hours. Around here anyway it's strictly 9 to 5 with no late hour days and no Saturday at all. I had to lose half a days work or even a day to get blood drawn.

Now there are closer doctors, but not an insuance approved blood work lab. And the doctors in these small towns tend to turn over a lot. When I moved for work, I kept my old doctor because it was a larger practice with more experience and more access to consultations and expertise. And because it was a multiple doctor practice associated with a medical school hospital I had reasonable hope it would still be there when I aged into medicare. Even a decade ago I was aware of problems developing where doctors didn't take new patients on medicare.

Now that I'm alone again, if I get too sick to drive an hour, I guess I'll have to make it on my own or go to the local emergency room mysef, even though I have insurance.

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