Medical Doctor Alternatives


I think that one of the reasons our medical care system is so expensive is that the system is not built to match procedure to appropriate expert.

For example, there are very skilled landscapers in this world capable of designing and building stunning works of art in the natural world.  And then there is the need to have your lawn mowed.  Imagine how expensive it would be to obtain a contractor to mow your lawn if you were required to hire that highly skilled, trained and often time licensed landscape designer.

Another example I came across was during a conversation with my mother-in-law.  We were discussing health care and costs and I mentioned that it’s unfortunate that I need to see an MD to have a finger reset, x-rayed and cast when I’m sure it could be done by a PA at most and perhaps a nurse at worst.

[ there may be cases where this is possible – i was using the specific example to make the larger point ]

She objected claiming that if it was her, and had she the insurance that she indeed has, she would insist on not only a doctor but then an orthopedic specialist.

Why the editorial?  I saw this and was confronted that without allowing price to act as a signal, we may not be getting optimal results:

Midwives, nurse practitioners, physician assistants and other non-doctors do as good a job as MDs in the care they deliver — and patients often like them better, a World Health Organization team reported on Thursday.

These non-physicians are especially effective in delivering babies, taking care of people infected with the AIDS virus, and helping people care for chronic diseases such as diabetes and high blood pressure, the team reported in a WHO bulletin.

The findings extend from the poorest nations to the United States and Europe, they said. While some physician groups have resisted wider use of such professionals, they should embrace them because they are often less expensive to deploy and are far more willing to work in rural areas, the WHO experts said.

“There are some obvious advantages in terms of relying on mid-level health workers,” WHO’s Giorgio Cometto told NBC news in a telephone interview.

“They take less time to be trained. Typically, they cost less to remunerate. In some countries they are more likely to be retained in rural areas.”

David Auerbach, a researcher at the Rand Corp., says other studies have shown the same thing. “There’s really not much difference you can find in the quality,” he said.

But we don’t allow the delivery of medical services be exposed to the market.  And so people are not going to shop their needs on said market.  Additionally, we have special interest groups, read AMA, that lobby to create legislation that make it illegal to see anyone BUT a doctor for such commoditized services.


One response to “Medical Doctor Alternatives

  1. In Singapore, they have prices for health care, and even when these prices are set by the state in government health care facilities, they are not too far from market prices. Almost everyone everyone has to pay these prices, or some substantial part of them, except for catastrophic health care. Almost everyone in Singapore has catastrophic coverage, but has to pay for normal health care themselves, in whole or substantial part.

    Singapore has quite a lot of government intervention in health care, so some people point to Singapore and say “See, capitalist health care works”, and other people point to Singapore and say “See, socialist health care can work”, but the big difference between Singapore and most other countries is incentives: That most health care in Singapore is paid for by the person receiving it, that health care in Singapore is, for the most part, paid for by the customer, and that doctors therefore answer to the customer, not the bureaucrat. He who pays the piper, calls the tune. If Singaporean healthcare is more capitalist than that of the rest of the world, this is an almost accidental and perhaps unintended consequence of the fact that people have to pay for it themselves.

    Grandma dying of cancer is the same problem in Singapore as under socialist health care systems (she and her doctors are tempted to run up excessive bills) since most people in Singapore have catastrophe insurance, but with regular health care, people only pay for if it is worth the price.

    Guess what? Singaporeans, having to pay for health care from their own pockets, do not buy much health care at all, and despite that, have very good health outcomes. That total health care expenditures in Singapore are remarkably small indicates that Grandma dying of the ailments of old age is not the problem. The problem is incentives for young healthy people, for that is the big difference with Singapore.

    Since Singaporeans get good health outcomes, they are not under-consuming health care.

    Therefore people in other countries are over-consuming health care – which is what we would expect if health care is free or heavily subsidized.

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