We-Have-to-Pass-It-to-See-What’s-In-It Fact of the Day
The coming doctor shortage we predicted here is going to get worse. The federal health overhaul could dry up funds that academic medical centers use to produce doctors. For example, leaders of six Texas health science centers are warning that:
- The Legislature currently provides state funds to cover only $200,000 of the average $800,000 cost of educating a physician in Texas.
- Much of the rest comes from “practice plans,” in which medical professors are paid from hospital patients’ insurance payments (primarily Medicare and Medicaid), and from additional federal funds for treating a lot of low-income patients.
- Under the federal legislation, “Disproportionate Share Hospital” payments under Medicaid and Medicare will be cut drastically, starting in 2014, and funds for Medicare are already being cut.
Easy to solve. Get more foreign born and foreign educated physicians. I seem to remember that there’s a recent study that shows they get better outcomes than us born physicians.
I think this is going to be a huge problem. And the idea of solving it with foreign-born physicians is not going to sit well with most people.
Health Affairs has been suggesting substituting nurses for doctors, but the nursing shortage is going to be even greater than the doctor shortage.
Think again if you believe that foreign healthcare workers, including doctors, will solve the doctor shortages in the U.S. The U.S. is not the only country to be facing healthcare worker shortages. Virtually ever country in the world has been confronted with the same dilemma. Other foreign countries like Australia and the UK are already using foreign doctors. Foreign physicians comprise about 25% of the doctors curently practicing in the U.S.
A few medical schools are experimenting with 3-year medical degrees (as opposed to 4-year) for those willing to enter primary care. Texas Tech even throws in some additional scholarship money so it reduces student debt by about $50,000. It’s currently limited to only a handful of people.
Disproportionate share payments were instituted in order to compensate hospitals for the costs incurred under EMTALA. States have control over how they are allocated. In many cases they have been used to subsidize state Medicaid expansions, not to compensate hospitals for actual uncompensated care.
The game is that the state sets low Medicaid reimbursement rates in order to keep Medicaid expansion costs low. But favored hospitals that serve a lot of Medicaid patients through federally qualified health clinics (which get paid their “reasonable cost”) get extra compensation via allocations of DSH funds that are distributed only to hospitals that have X percentage of Medicaid patients in their population, patients that have coverage, at least in theory.
Under ObamaCare, everyone will have insurance and disproportionate share payments will no longer be needed.
What’s the problem?
I was going to say exactly what Linda said. Don’t forget that half of the newly insured will be privately insured and half will be on medicaid. DSH payments pay drastically less than Medicaid pays, per patient, and the convoluted system surrounding DSH payments makes them basically functionless.
Also, how about we stop subsidizing medical school? This seems to be the best free-market solution.