Socialistic service levels without socialism

Opponents of socialized medicine correctly point to long waiting lists as one of the downsides of such a system. The unstated assumption is that waiting lists are absent in our “free market” system. But here in Massachusetts, patients already contend with long waiting lists.

Physicians consider anything up to a 2 week wait to be reasonable. But a survey of physicians conducted by MHA Group, as reported in the Boston Globe, found the following average wait times for an appointment:

  • Orthopedic surgery –18 days
  • Cardiology –32 days
  • OB/Gyn –39 days
  • Internal medicine –42 days
  • Gastroenterology –44 days

Physicians point to the high cost of living in Massachusetts, low reimbursement rates, and high malpractice premiums as the causes of the problem.

But that’s probably not the real problem. As Murray and Berwick wrote in 2003 in JAMA,

Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources.

June 8, 2005

2 thoughts on “Socialistic service levels without socialism”

  1. There IS more to it than low reimbursement and high malpractice premiums, although these are relevant.

    Consider also overuse of medical services. Overuse is driven both by providers (possibly for because we need to make money on volume) and by patients for whom the financial barriers are so low as to remove any disincentive to see the doctor when it isn’t really necessary.

    Co-pays and/or deductibles should be larger.

Leave a Reply

Your email address will not be published. Required fields are marked *