Health Care and Restaurants

Health Care and Restaurants

Why do people chose one restaurant over another? Why do some restaurants succeed while others fail? The answer typically relates to quality, service and associated high levels of client satisfaction.

What if restaurants were required to identify all of their dishes by standardized code numbers and relative value indices were assigned to each code and if the establishment had to charge their clients exactly the same price for each identifier?

Would anyone be surprised if restaurant owners, under such a system, gave up on innovation and creativity? Would there be any incentive for restaurant owners to work hard and be diligent?

So why does government demand this of medical physicians? There are now 10,000+ ICD-9 codes, related Diagnosis Related Groups (DRGs) and a Relative Value Index (RVI) in medicine.

On September 9, 2002 health care consultant James Orlikoff pointed out that the typical (economically unproductive) physician response to decreased reimbursement was to work harder and see more patients. While economists recognize that losing money on each encounter is not alleviated by increasing volume it must also, in the opinion of Burton Report^®,be pointed out that the greatest strength of medical practice is the inherent bent of physicians to work hard and be diligent.

There is a movement afoot to consider medical services as packaged and uniform (much like pork bellies) and to "lobotomize" physicians to provide these uniform and measurable services.

Someone has apparently forgotten the "restaurant principle" of quality, service, and patient satisfaction. Yes, it would be great for the United States Internal Revenue Service (IRS) if everyone were an "employee" subject to uniform monitoring of earnings and taxation and the government would like to see physicians in this situation. As the cost of health care increases there is any alternative to managed or socialized care?

The Washington Post reported that in 1996 60% of all Americans were enrolled in some form of managed health care (most common being HMOs). Is it possible to maintain lower health care costs and not "lobotomize" the medical profession?

Of course it is, but the paradigm has to change. First of all the patient has to be the "gatekeeper' and the "shareholder" for their health destiny rather than abrogating this to a third party uninterested in the patient's welfare. If Independent Health Maintenance Programs (such as Medical Savings Accounts) were more prevalent and patients basically spent their own money on choices they made quality, service, and patient satisfaction would become bywords.

Why not encourage medical centers of excellence, physician industry and diligence? It's not hard to do. Why not have every patient, at the completion of their treatment fill out, and submit to an uninterested third party, a questionnaire (such as the Prolo and Oswestry scoring systems) as determinants of patient outcomes and patient satisfaction. What else really matters? Trust patients to seek out the best physicians and hospitals as they do restaurants.

Regina Hertzlinger points out that: We can change this with a consumer-driven health care system that rewards productivity by empowering providers and consumers. Providers could price and design services, absent insurer and government micromanagement; consumer s could choose from a wide choice of insurance plans, offered by their employers along with excellent information to support their decision-making. The resulting market-driven competition is much more likely to create the efficiencies that can broaden access to health care." (Hertzlinger R: Prix-Fixe Rip Off, Wall St. J., June 13, 2003)

P.S.
If you were a restaurateur and your clients decided to pay only 35-50% of their checks would you find this disturbing? Would you accept this? How, then exactly, would you respond?