Health Care Anew

Our archaic system of paying doctors and hospitals is beginning to cause problems. 

The Boston press recently carried a story about a patient who got a few pre-cancerous skin spots removed in what appeared to be the private office of his Dermatologist.  He got the doctor’s bill in what seemed to be a reasonable amount and was then shocked a few days later to get a bill for $1,525 from a nearby hospital for “operating room and other hospital charges.” 

The February 5 issue of The Boston Globe editorialized against such charges, but without seeming to understand the origins of the problem. 

In recognition of the traditional independence of the medical profession, payments to doctors have been kept separate from payments to hospitals.  Thus we have Blue Cross and Medicare Part A for hospitals and Blue Shield and Medicare Part B for doctors.

Originally, hospital outpatient departments were for poor people. Physician care was provided by interns and residents under the supervision of attending staff who served without pay.  Then Medicare and Medicaid came along and insured many of those people.  But outpatient care was insured on the doctor side and there was no provision for paying the hospital.  Eventually that was changed so that insurance paid both. 

As time went by, hospitals started buying up physician practices, many of which continued to operate in private offices.  Hospitals apparently found that in these circumstances they could make a hospital charge as well as a professional fee charge – something obviously not intended when the dual-billing system was created. 

That is the sort of thing that happens when financial arrangements don’t keep up with the times.