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Author Topic: 50 days to see a doctor in Boston…Is universal coverage the cause?  (Read 3548 times)
phk
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« on: June 11, 2009, 06:13:19 pm »
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50 days to see a doctor in Boston…Is Massachusetts’ universal coverage laws the cause?


From the USA Today, here are the wait times to see a doctor in the following cities:

    * Boston: 49.6
    * Philadelphia: 27
    * Los Angeles: 24.2
    * Houston: 23.4
    * Washington, D.C.: 22.6
    * San Diego 20.2
    * Minneapolis: 19.8
    * Dallas: 19.2
    * New York: 19.2
    * Denver: 15.4 days
    * Miami: 15.4 days

The first thing that jumps out from these numbers is that Boston has by far the longest wait to see a doctor.  Is this caused by the universal health coverage enacted in Massachusetts?  The answer is maybe.  Physician supply adjusts slowly (i.e., it takes a long time to finish med school).  On the other hand, Massachusetts decision to increase insurance coverage lead to a spike in the demand for medical services.  Thus, universal health care may have caused the run up in wait times, but this phenomenon may be short lived.  Physicians may migrate to Massachusetts as insurance coverage becomes more available. 

Do wait times reflect quality of care?  If Boston residents have very short waits to see nurse practitioners or physicians assistants, this could be a cost-effective substitute for services provided by physicians in the primary care setting.  Further, longer wait times for specialists could be a good thing.  While longer wait times would certainly hurt some patients–likely the most seriously ill patients–it would discourage other patients from waiting to see a specialist.  This patients could, instead, forego treatment if had a low marginal benefit to begin with or they could rely on their primary care provider. 

Let’s dig deeper into the numbers (see original report):

    * Wait times for Boston cardiologists decreased from 37 days in 2004 to 21 days in 2009. 
    * Wait times for Boston orthopedic surgery increased from 24 days in 2004 to 40 days in 2009. 
    * Wait times for a Boston ObGyn increased from 45 to 70 days between 2004 and 2009 in Boston.
    * Wait times for a Boston Family Practice physician was 63 days in 2009.

We see that after the Massachusetts health reform was enacted, there was no uniform effect on specialist wait times, but there was a large increase in wait times for primary care providers.  This could be explained by a number of phenomenon:

    * Those who gained health insurance after the Massachusetts health reform were a healthier population and used their new insurance coverage to increase the number of primary care visits, but not specialist visits.
    * After the Massachusetts health reform, the increase in demand was homogenous across primary and specialty care.  However, physician supply adjusted.  Specialist may have been more attracted to practicing in Massachusetts, but primary care doctors were not.  Specialists may have moved to Massachusetts in larger numbers, particularly if New England health plans reimburse specialists at a much higher rate. 
    * This could be a statistical anomaly.  Sample sizes in were less than 20 for five specialities in Boston.
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Sewer
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« Reply #1 on: June 11, 2009, 06:26:12 pm »
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No.
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Marokai Besieged
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« Reply #2 on: June 11, 2009, 06:38:32 pm »
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No.
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afleitch
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« Reply #3 on: June 11, 2009, 06:40:53 pm »
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No.

As you know I'm a UK resident. I felt unwell last night so I wanted to see a doctor and I did at 11am the next morning after booking an appointment at 8.30 am. Cost me nothing, bar a $6.50 flat fee for a prescription afterwards.

So many people knock such a system without knowing the slightest thing about it.
« Last Edit: June 12, 2009, 04:05:12 am by afleitch »Logged

Benwah [why on Earth do I post something] Courseyay
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« Reply #4 on: June 12, 2009, 08:46:29 am »
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Last time I needed a doctor, I called it in the morning and was received in the afternoon, same for my bro and an other doctor, and it used to be this way until now for people I know. And you might have seen that I live in France, which has a universal medical coverage.

Maybe it's a bit more time for dentists, but not that much, maybe 2 or 3 days to wait, except emergences. For specialists like ophthalmologist it can be way longer, but here it is due to the fact that not enough students choose such or such specialized field of medicine, so it misses some doctors in such or such field of medicine.

I recently saw a report in which an NGO gave some care in general medicine and for teeth, for a lot of people who didn't have money, and who came there to benefit of some medical care. The NGO gathered them in a gymnasium, and a long queue was waiting, each one its turn. This happened in the US, nowadays. That may be what you prefer...
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« Reply #5 on: June 14, 2009, 12:30:28 am »
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No.

As you know I'm a UK resident. I felt unwell last night so I wanted to see a doctor and I did at 11am the next morning after booking an appointment at 8.30 am. Cost me nothing, bar a $6.50 flat fee for a prescription afterwards.

So many people knock such a system without knowing the slightest thing about it.

Anecdotal evidence is awesome!

Just try not to get cancer in Scotland.
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« Reply #6 on: June 14, 2009, 12:38:30 am »
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No.

As you know I'm a UK resident. I felt unwell last night so I wanted to see a doctor and I did at 11am the next morning after booking an appointment at 8.30 am. Cost me nothing, bar a $6.50 flat fee for a prescription afterwards.

So many people knock such a system without knowing the slightest thing about it.

Anecdotal evidence is awesome!

Just try not to get cancer in Scotland.
Do you have any evidence that suggests extremely long wait times in Scotland? I'd like to see it...
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« Reply #7 on: June 14, 2009, 12:49:31 pm »
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No.

As you know I'm a UK resident. I felt unwell last night so I wanted to see a doctor and I did at 11am the next morning after booking an appointment at 8.30 am. Cost me nothing, bar a $6.50 flat fee for a prescription afterwards.

So many people knock such a system without knowing the slightest thing about it.

Anecdotal evidence is awesome!

Just try not to get cancer in Scotland.

Yeah, and don't get it in the U.S. either.  Because here you just won't be treated.  And if you are, it will probably be untimely and you will still die from it and then your family gets to pay the tens of thousands of dollars in medical debt.  Hope they have a house or something to sell to pay that off!
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« Reply #8 on: June 14, 2009, 01:52:01 pm »
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No.

As you know I'm a UK resident. I felt unwell last night so I wanted to see a doctor and I did at 11am the next morning after booking an appointment at 8.30 am. Cost me nothing, bar a $6.50 flat fee for a prescription afterwards.

So many people knock such a system without knowing the slightest thing about it.

Oh no, they know everything they need to know about it - it reduces the massive income of the health care mafia, and it wastes resources on sick poors.  Believe me, they don't knock it because they actually fear the mythical 'doctor wait', which is obviously an absurd canard.
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Benwah [why on Earth do I post something] Courseyay
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« Reply #9 on: June 16, 2009, 02:49:00 pm »
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No.

As you know I'm a UK resident. I felt unwell last night so I wanted to see a doctor and I did at 11am the next morning after booking an appointment at 8.30 am. Cost me nothing, bar a $6.50 flat fee for a prescription afterwards.

So many people knock such a system without knowing the slightest thing about it.

Oh no, they know everything they need to know about it - it reduces the massive income of the health care mafia, and it wastes resources on sick poors.

Mouhahaah. Is that ironical?

What a cool mafia, a mafia that give money and care to the people...
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« Reply #10 on: June 16, 2009, 03:00:01 pm »
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No.

As you know I'm a UK resident. I felt unwell last night so I wanted to see a doctor and I did at 11am the next morning after booking an appointment at 8.30 am. Cost me nothing, bar a $6.50 flat fee for a prescription afterwards.

So many people knock such a system without knowing the slightest thing about it.

Anecdotal evidence is awesome!

Just try not to get cancer in Scotland.

At least he would get treated in Scotland. Here he would have to fight tooth and nail with his insurance company to get any treatment at all. Even then if he wanted the latest treatment he would have to pay tens of thousands out of his own pocket. America's health care system is the best in the world for the elite (and by elite I mean someone making millions) but not so great for the rest of us. I would much prefer a system like Europe where I won't have to spend my dying days haggling with my insurance company.
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The Duke
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« Reply #11 on: June 16, 2009, 05:08:17 pm »
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The raw ideology on this board is mind boggling.

The facts are that wait times are not just a little longer but significantly longer in Britain than in the US and survival rates for cancer patients are much lower.  That anyone would deny this at this stage suggests a total immunity to evidence.
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« Reply #12 on: June 16, 2009, 05:24:30 pm »
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The raw ideology on this board is mind boggling.

The facts are that wait times are not just a little longer but significantly longer in Britain than in the US and survival rates for cancer patients are much lower.  That anyone would deny this at this stage suggests a total immunity to evidence.
Cite?
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Benwah [why on Earth do I post something] Courseyay
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« Reply #13 on: June 17, 2009, 07:36:58 am »
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The raw ideology on this board is mind boggling.

The facts are that wait times are not just a little longer but significantly longer in Britain than in the US and survival rates for cancer patients are much lower.  That anyone would deny this at this stage suggests a total immunity to evidence.

If you open a world map of health care, you might find other states than US and UK. Among the other ones, you might find the Scandinavian ones and France. Maybe you should have a look. France uses to consider the UK cover as not being an example at all.
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« Reply #14 on: June 17, 2009, 08:03:01 am »
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you will still die from it and then your family gets to pay the tens of thousands of dollars in medical debt.  Hope they have a house or something to sell to pay that off!

Nonsense of course. I have a LOT of experience with that situation and I call BS.
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« Reply #15 on: June 17, 2009, 11:41:27 am »
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The raw ideology on this board is mind boggling.

What ideology?  Its simple reason - those of us who don't have health insurance can never see a doctor.  The wait is forever.  So, the wait would be less long under socialized medicine.

The facts are that wait times are not just a little longer but significantly longer in Britain than in the US and survival rates for cancer patients are much lower.  That anyone would deny this at this stage suggests a total immunity to evidence.

'Facts'?  You mean facts are what some fascist asshole claims on a message board?  Your claims are obviously utter nonsense, Ford.

you will still die from it and then your family gets to pay the tens of thousands of dollars in medical debt.  Hope they have a house or something to sell to pay that off!

Nonsense of course. I have a LOT of experience with that situation and I call BS.

Come on States everyone knows people who have tens of thousands in medical debt - I know 3 people like that myself.
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« Reply #16 on: June 17, 2009, 12:46:06 pm »
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you will still die from it and then your family gets to pay the tens of thousands of dollars in medical debt.  Hope they have a house or something to sell to pay that off!

Nonsense of course. I have a LOT of experience with that situation and I call BS.

The leading cause of bankruptcy in America is due to health costs. And most of those people had insurance coverage.
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« Reply #17 on: June 17, 2009, 02:09:32 pm »
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The raw ideology on this board is mind boggling.

The facts are that wait times are not just a little longer but significantly longer in Britain than in the US and survival rates for cancer patients are much lower.  That anyone would deny this at this stage suggests a total immunity to evidence.

If you open a world map of health care, you might find other states than US and UK. Among the other ones, you might find the Scandinavian ones and France. Maybe you should have a look. France uses to consider the UK cover as not being an example at all.

The WHO rates the US quality of care as better than the French or Scandanavian systems, btw.
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« Reply #18 on: June 17, 2009, 02:11:40 pm »
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The raw ideology on this board is mind boggling.

The facts are that wait times are not just a little longer but significantly longer in Britain than in the US and survival rates for cancer patients are much lower.  That anyone would deny this at this stage suggests a total immunity to evidence.

If you open a world map of health care, you might find other states than US and UK. Among the other ones, you might find the Scandinavian ones and France. Maybe you should have a look. France uses to consider the UK cover as not being an example at all.

The WHO rates the US quality of care as better than the French or Scandanavian systems, btw.

For those who have access to it, absolutely.
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« Reply #19 on: June 17, 2009, 03:16:30 pm »
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The raw ideology on this board is mind boggling.

The facts are that wait times are not just a little longer but significantly longer in Britain than in the US and survival rates for cancer patients are much lower.  That anyone would deny this at this stage suggests a total immunity to evidence.

If you open a world map of health care, you might find other states than US and UK. Among the other ones, you might find the Scandinavian ones and France. Maybe you should have a look. France uses to consider the UK cover as not being an example at all.

The WHO rates the US quality of care as better than the French or Scandanavian systems, btw.

For those who have access to it, absolutely.

I don't especially know of it, I just know that in France you can be offered for low costs some very good high and last technologies to diagnose and to treat you. But, anyways, yes, if we take in count the number of people who can access to high quality cares here for low costs, if we take both criteria in count, then the classification of health cover won't be the same.

It's a choice, or you just care of the quality, or you care of the quality and of the quantity that you can give. Free to you to chose, but personally I'd rather live in a society which take care of the most important in life >>> health.

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« Reply #20 on: June 17, 2009, 04:13:18 pm »
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For those who have access to it, absolutely.

The real misunderstanding of health care is just how few actually do have access.  Sure, lots of dumb working stiffs think they have access to health care, because they get some crappy insurance through their job.  But as soon as they actually get seriously ill they find out that the insurance company finds some way to deny them, or even if it pays for a while, once they get too ill to work they lose their job and with it their health care (and all income). 

So in practice only very wealthy people have secure access to health care in the US.
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« Reply #21 on: June 17, 2009, 06:44:01 pm »
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Where does this canard come from that those who have no nsurance have no access to care?

I understand Europeans not understanding that even the uninsured get health care in the US because they don't live here and experience the American system every day, but I don't understand how American posters can know so little about their own health care system.
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« Reply #22 on: June 17, 2009, 08:05:15 pm »
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you will still die from it and then your family gets to pay the tens of thousands of dollars in medical debt.  Hope they have a house or something to sell to pay that off!

Nonsense of course. I have a LOT of experience with that situation and I call BS.

The leading cause of bankruptcy in America is due to health costs. And most of those people had insurance coverage.

He was saying WHEN YOU DIE. I know for a fact that if you call those billing you when a relative dies 95% of the medical places will waive the charges. When my father passed last year I called around and had nearly 15,000 dollars in medical charges waived. I only ended up paying 250$.
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« Reply #23 on: June 17, 2009, 08:22:01 pm »
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The problem is that many people view health care as an entitlement, while that may or may not be case this leads to an unsavory end. That whether they have insurance or in a Gov't plan should one be created people just go to the nearest medical facililty and plop down there card and are done. What people need to do is treat its as a commodity and search for the lowest prices. Costs can very depending on the facililty by as much as 25% depending on where you go. People need to learn to ask questions, especially if there are generics available which can save large sums as well. The information is available the trouble is no one bothers to look it up even for the most trivial elective procedures. Don't get me wrong I support some kind of reform that covers the uninsured, I just think that unless this is addressed we will never be able to afford any reform.

CBO says it will take 100 Billion dollars a year to cover only 20 million uninsured people, Didn't Hillary claim that she would cover all uninsured? Remember what here price tag was, 100 Billion a year. I think CBO is wrong, usually they are but not in the direction Dems hope they are wrong. They are still probably underestimating the true costs of Health Care reform. People have got to take more responsibililty for the own care otherwise costs will never go down and they will also keep living unhealthy lifestyles making care even more expensive.
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« Reply #24 on: June 17, 2009, 10:34:19 pm »
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Where does this canard come from that those who have no nsurance have no access to care?

Actually that is one of the problems with our system. Of course they have access to healthcare. If you call 911 when you have a heart attack and they take you to the ER, you will get treated regardless of whether you have insurance or not. But what happens in the aftermath? Who pays those costs? Especially considering that the uninsured tend to be the poorest Americans. They end up going bankrupt or the costs never get paid. In effect the rest of us pay for it. Wouldn't it be better if we gave them access to a doctor and drugs before they get a heart attack in their 50's? Don't you think that would be better for society in other ways as well, such as greater productivity? I realize things get much more complicated when surgeries are needed or diseases like cancer or diabetes need to be treated, but can we at least agree that everyone deserves access to a doctor at a low cost?
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