A bigger health-care issue

Insurance reform won’t mean much if there are no family doctors

Dr. Dolinar, medical director of Bidwell Pediatrics, is leaving private practice and becoming a clinician at the Enloe Children’s Health Center.

As a doctor, I care about the state of health care in our country. There is a big push for reform, which is a relief, because I see first-hand the problems in the system. But all the focus on one element leads people to overlook the big picture.

Insurance obviously is a big concern, because health care, as much as we don’t want it to be, is a business. I know that particularly well because I opened my own practice and, just more than three years later, it’s now closing.

Bidwell Pediatrics couldn’t maintain what’s called a “healthy payer mix”—the balance between private insurance and public insurance. Medicare and Medi-Cal do not reimburse doctors at the same level as Blue Cross and Blue Shield do. It’s as if you went to a hair salon for cut and color, and the stylist could collect $90 from one woman but only $10 from another. That would influence which clients get appointments.

A haircut is one thing; health care is another. For me, it’s heart-wrenching to turn away children who need a physician just because of the financial situation of their parents or guardians. The payer mix at my closing practice shows how often my heart has overridden my business brain.

Fortunately, I’m able to stay in Chico. Enloe Medical Center is contracting with me to work in the Children’s Health Center on Cohasset. There, I will get to see patients who need care, regardless of insurance—ECHC accepts all sorts of plans and, in one of the many wrinkles in the system, gets higher reimbursements than individual doctors.

Insurance reform clearly would alter the medical landscape. If nothing else, it might create an incentive for more aspiring physicians to go into primary care rather than specialties that pay much better.

Why patients should care about this is because of another business reality: supply and demand. Already it is difficult for Chicoans to find primary care. Had I been forced to leave, several thousand children would have been left without a doctor, and those on Medi-Cal would have had a particularly difficult time finding a new one.

That’s part and parcel of the bigger issue surrounding health care: access. Will “cookie-cutter medicine,” dictated by insurance companies and the government, replace independent medical judgment? In this challenging environment, will there be enough doctors, nurses, facilities, equipment and medicines?

Yes, insurance needs reforming, but it doesn’t matter whether an insurer pays $15 or $150 if there’s no one available to provide the care.