[quote=ocrenter] . . . But in a PPO world the 10 people with chest pain will ALL go to the cardiologist. And because the cardiologist owns a treadmill and he can bill for it, ALL 10 will get the stress treadmill. And because the stress treadmill creates a lot of false positives, now we got 5 positive treadmill studies that the cardiologist will REFER to his buddy who owns a nuclear medicine suite who will then get to do 5 nuclear medicine stress test, of the 1 really has the heart issue, that person then gets the angiogram.
So now we all end up paying for 10 cardiologist bills, 10 treadmills, and 5 nuc med stress tests plus the one angiogram under the PPO system. But in the HMO plan we pay for 3 treadmills and one angiogram.
So granted you get what you think you want, but ultimately everyone loses.[/quote]
ocrenter, how do you surmise that “everyone pays” the PPO bills of those who have “choice” in their healthcare decisions?
First of all, the monthly premiums for low-deductible PPO’s (=<$500) are 30-50% HIGHER than HMO premiums. Second of all, nearly half of "PPO policyholders" have (more-affordable) high-deductible health plans (HDHP's) which have a $3000 - $8000 annual deductible (avg $5000). How much do you think an HDHP is going to pay out-of-pocket for your "chest-pain odyssey??" Do you actually think a person with a deductible of say, $5000, is going to check into an emergency room complaining of "phantom" chest-pain?? No, they may pay a $50 co-pay to see a cardiologist. But the party stops at that first “specialist-office call,” ocrenter!!
The reality is, if this patient had spent little to no healthcare costs towards their $5000 deductible in that calendar year, the full cost of all those supposedly “unnecessary” tests will come out of that patient/insured’s pocket, NOT the insurer’s or taxpayers!
An HMO member can just pay $15 each (or whatever the current “co-pay” amount is), to every practitioner they see and get seen into oblivion (or as much as their “system” will allow). They will pay zero for x-rays and tests that a ($15) practitioner (who already examined them) ORDERED. The purpose of the “gatekeeper PCP” in an HMO is to keep all their member-repeat patients with “chronic hangnails” from “working the system” for no reason. Unfortunately, the truly sick often fall through the cracks with this “business model.”
I maintain that when routine healthcare comes out of a patient’s pocket, not only do they tend to take better care of themselves, they don’t visit a doctor just for the h@ll of it.
