Cohousing-L Mailing List: Re: Insurance-free healthcare

[Saramandaia Farm (etaincr]

I've had a private practice that was basically fee-for-service.  I  practiced 
in the Fort Lauderdale area, and didn't accept insurance  because I didn't want 
to do the paperwork/dealing with jerks it  required, and because I did home 
births, which were generally not  covered by insurers or HMOs...there were 
exceptions.  I also had  seen that health insurance coverage frequently changed 
depending on  things like who was the lowest bidder (great, eh?), or which 
union  official accepted which bribe from which HMO to secure the contract for  
the large employers...often teachers unions or postal workers, or some  such.  
This left people distraught at having to change  docs...often in mid-pregnancy 
or mid-chemotherapy... and fragmented  care.  So we were a cash practice and we 
helped patients with  their insurance forms...I had an office managers whose 
work that  was.  I had ~2,500 active charts, and saw 15-20 patients a day in  
about 8 hours.  I did and do make
 house-calls...can't really  attend home births otherwise.  I don't maintain an 
office in Costa  Rica, in fact...I work from my home or theirs.  But even 
comparing  the two places and their different cultural and governmental issues 
is  pretty much impossible.  We have a national health system here,  which 
everyone can use.  And no one here would come to a doctor  for a 
less-than-serious complaint.  US docs spend much of their  time and waste  
their specific medical skills on the worried well.
  
  The point is not turning turning co-housing into assisted care...the  
original question was whether access to on-site health care access  would be 
attractive to prospective residents, I think.  Family  docs, at least, treat 
families.  Young and older members.    Gerontologists or, really, 
geriatricians, deal almost exclusively with  the problems of older 
people...often thought of as Medicare age and  older.  
  
  Issues like choice of care-givers, ancillary services,  available  social 
services...all those are kind of separate.  I think it  would depend on what 
the community decided to invest its energy  in...on-site doc, on-site mid-level 
(P.A., N.P.), on-site help with  insurance paperwork, on-site phlebotomy 
(blood-drawing), transportation  to off-site resources.  The list is long.  And 
every  community would and does handle it in a different way.  Here in  Costa 
Rica, every town or village has a "health unit", where routine  stuff is 
done...well-baby care, immunizations, monthly glucose testing  for diabetics, 
BP readings for hypertensives, Pap smears, sometimes  prenantal visits, and 
immediate care not requiring transport to a  hospital.  Saves everyone (most of 
the people here don't have  cars) a trip to facilities half an hour or more 
away.   Emergencies, serious health problems, and complications of pregnancy or 
 labor are dealt with at the national hospitals.  The nurses
 and  docs at the village/town level pretty much know the patients...they're  
neighbors.  Works for here...might not everywhere.
  
  From a doctor's standpoint, more problematic would be malpractice  insurance 
(I didn't carry any in Florida...I was uninsurable anyway  because of the home 
births) and overhead expenses, including  staff.  I always work with one nurse 
(often a midwife).  In  my larger practice, I employed a nurse and an office 
manager...but that  was it. 
  
  It's enjoyable having a somewhat seamless life.  My home is my  work is my 
family are my friends etc.  Sometimes it's a pain in  the ass, and more 
separation sounds nice.  But those are just my  preoccupations, and I really 
suspect that it's not a style that people  in the US would warm up to.  
Everyone seemed always to want "the  BIGGEST heart man at Columbia 
Presbytarian", or the CT for frequent  headaches, or testing for a zillion rare 
diseases out of worry.
  
  This may be more than anyone wants to hear, but, hell, chairs and acoustics 
aren't too interesting either.
  
  I should say that I never made much money in private practice:)
  
  Sharon
  
                
---------------------------------
Get amazing travel prices for air and hotel in one click on Yahoo! FareChase