Mythical & Modern Medicine (cntd) 3/29/2021 6:40:08 AM
Health Insurance. At the start of medical practice the payment was 'gratis' or paid by whatever the recipient could give back. As medicine became a profession, money, in addition to gratitude became the norm. The doctor and patients knew each other and the doctor charged depending on what he thought the financial capability of the patient could bear. Sometimes nothing. Then it changed to a fixed fee. A few companies introduced the concept of insurance, as medicine, specially hospitalization became common.
As life expectancy increased and more and more medical conditions became treatable, specially in old age, it became clear that most old people could not afford the cost of their treatment. So Medicare and Medicaid as insurance for the old, disabled and poor came into being. This gradually became a reliable and dependable part of a doctor's income. Inevitably it brought with it it's own consequences. A new bureaucracy was created with attendant results of rules and regulations. There was now little or no exchange of the value of service or fee between patient and physician increasing the distance between them. The patient knew that the doctor got paid and since it did not come directly from him, the what when and how became of little concern to him. Another factor in the impersonalization of medicine. The fact that a particular test or treatment was expensive was of no concern. Everyone naturally wanted the best.
On the medical side it was abused as the doctor felt that it was not coming out of the patient's pocket. Little or no concern was shown to the cost of tests or treatment. So if a test or consultation was not really necessary but needed to confirm or make the doctor more comfortable, it was ordered. Waste and abuse also crept in. Then gradually fraud by some.
Since all this lead lead to an unsustainable cost to Insurances- consequences followed. Rules and regulations, inspection of patient records, 'cook-book medicine , deductible's, refusal of payments and others soon followed. A simple transaction of fee for service became a complicated mess as more and more things came between the patient and physician. ( cont.)
