If patients need to be coached to simply make an appointment, how can we expect them to shop around for the best care as they would need to do in a privatized, voucher system?
That indeed is the problem. The fact is that most primary care physicians are more then capable of. Thoma states from the reference:
Two-thirds of newly diagnosed cancer patients unable to obtain oncology appointments, EurekAlert: Newly diagnosed cancer patients frequently face hurdles in obtaining an appointment for care with an oncologist, according to new research from the Perelman School of Medicine at the University of Pennsylvania... Even callers with private health insurance had difficulty scheduling an appointment, with just 22 percent of them obtaining a slot, compared to 29 percent of uninsured patients and 17 percent of patients on Medicaid, according to results of a study in which research assistants posed as patients seeking an initial evaluation.
They conclude that some form of medical navigator is essential. It used to be the family physician who would help. That was fifty years ago. Today it is ever so much more complex. The specialists are truly specialists and patients are generally not able to create and present their case file.
For example if a patient goes to a primary care physician with a concern about a mole, the physician sends them to a dermatologist. In fact they may get a list of several to call. Which one? Then if they get an appointment, it may take a couple of visits and if the lesion is a melanoma, then what? It really depends. What level, and what treatment?
Does the patient then find some academic facility with a melanoma expert, and how would they choose the physician, and what must they bring, and the list of uncertainties goes on, and the costs increase.
The same is the case say with a prostate concern. Say the PSA velocity jumps, well above 0.75 per year. Does the patient find a urologist, then have a biopsy, then if it is HGPIN. Then how best to follow up, since 50% of the second biopsies can have Gleason 7 or higher. Then what?
How does the normal person navigate this?
I have seen a multiple set of ways. First a great primary care physician assists, but he is generally not paid for this. It is a gift. Second, the patient becomes a victim of the system and it is a crap shoot. Third is the take care type, a family member may be a nurser and then they get pushed here and there, still confused. Fourth is the physician as patient, they call around friends and by networking get themselves from the very beginning in the best route. That of course requires great insight and contacts. The problem often with physicians is that they are not the best patients and often delay and deny.
Thus this issue, not at all addressed in any health care plan, is a cause of much mortality and morbidity, not to mention costs.
Thoma's point is well taken, and worth some consideration.
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