Thursday, December 8

One issue per visit: A health-care inefficiency

When you have a public health care system (as we have in Canada), it can lead to inefficiencies.Carleton University's Health and Counselling Services provides a great example of this (hat tip to my fiancée, Laura). They have a rather strange policy: "Only one issue per visit will be addressed."

Let's say I have two issues I want to discuss with a doctor. Perhaps I'm concerned I have strep throat. Since I'm going to the doctor anyway, it would probably make sense to discuss a refill on a prescription that is expiring soon. Is it more efficient to tackle both these issues in one visit or in two separate visits?

One visit is clearly more efficient. That's because there are significant fixed costs associated with each visit. Regardless of whether I want to discuss one issue or 20 with the doctor, I have to travel to and from the clinic and wait in line once I get there. From the clinic's perspective, the receptionist has to greet me and deal with my paperwork each time I visit, clean the doctor's room, put a new one of those tissue paper coverings on the examination bed, and the doctor has to introduce themselves and review my file. These are fixed costs because they occur for each visit, regardless of how many issues are addressed.

In addition, the quality of medical care will likely decrease when doctors can only tackle one issue per visit. What if my strep throat-like symptoms are actually caused by a side effect of my prescription? That might not come up if I'm not allowed to discuss multiple issues with the doctor.

Of course, the doctor will need to spend more time with me if I wish to discuss more issues. But they'll have to eventually spend this time with me, whether I address the issue this visit or with a future visit.

So why would the health clinic of a university, which is supposed to be a bastion of knowledge, limit students to one issue per visit when it is clearly an inefficient system? Absent any explanation on Carleton's website, my bet is it's about the bottom line. Under a fee-for-service model, the government reimburses doctors based on the services they provide. With this system, the clinic gets $77.20 for each consultation a doctor does, whether it's about one issue or many (although doctors are paid more if the consultation goes over 50 minutes). If the clinic makes you come back twice for two problems, they earn twice as much.

If health care were privately provided, this probably wouldn't happen. When individuals have their own money at stake, they're going to make more efficient decisions than when everything is free. And in a competitive system, health care providers must operate effectively, or people will take their health care business elsewhere.

If patients had to pay twice as much out of their own pockets to deal with two problems (even though the total cost of treating two issues at once is less than treating them in two visits), those doctors would probably start losing their patients to ones who are willing to deal with multiple issues in one go. And society would be better off for it.