The Short Shrift of Healthcare: Profits Before Patients

Doctors are relatively uninformed about healthcare systems, outcomes research or healthcare economics, specifically the costs of care and cost-benefit. Couple that with what insurers are doing with our money and you can see who's getting the short shrift.

58,294 US medical graduates completed the Association of American Medical Colleges (AAMC) annual, 2003-2007 Medical School Graduation Questionnaire. The data were used to compare medical school curricula that varied in the intensity of teaching about health care systems.

Results: "The percentage of students reporting appropriate training was 90% to 92% for clinical decision making, 80% to 82% for clinical care, and 40% to 50% for the practice of medicine. Students from the school with a higher-intensity curriculum in health care systems reported higher satisfaction than students from the school with a lower-intensity curriculum for training in four of five practice of medicine components: medical economics, health care systems, managed care, and practice management. Importantly, the high commitment to education in health care systems in the higher-intensity curriculum did not lead to lower perceived levels of adequate training in other domains of instruction."

Patel MS, Lypson ML, Davis MM. "Medical Student Perceptions of Education in Health Care Systems." Academic Medicine, Sept. 2009;84(9):1301-1306

Dr. Chen, writing in the NY Times ("When the Patient Can’t Afford the Care." Feb. 4, 2010), says not only is it "possible to learn about the economic and social aspects of health care while immersed in the details of biology, physiology and pharmacology".... it is "impossible to become a good clinician without doing so." She quotes Dr. John E. Prescott, the chief academic officer for the AAMC: 'These are incredibly important topics.... Physicians knowing about the system and the environment in which they work, allows them to be better doctors. And that in turn allows them to take better care of their patients.'"

Also, we're spending too little of insurance premiums on healthcare.

The concept of the Medical Loss Ratio—the percentage of the premium dollars collected by the insurance company's that are actually spent on health care—helps explain how insurance companies are using you as their financial engine and what their priorities are.

The "health insurance industry says its average MLR is 87%," but, according to Senate research, it's significantly lower.

As stated in the Consumer Watchdog, Dec. 24, 2009, "The Senate bill's requirement that insurers spend 80% or 85% of the premiums they collect on health care services will—absent strict rate regulation—perversely encourage insurers to raise their premium rates. In the same way that a Hollywood agent who gets a 20% cut of an actor's salary has an incentive to seek the highest salary, insurers will have incentive to increase health care costs and raise premiums so that their 20% cut is a larger dollar amount."