Word: relman
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...Relman: Because it helps maintain the quality of information that gets to the public. The public interest is not served by rapid dissemination of premature, incomplete, inaccurate, sensational information. The public interest is better served by getting the facts straight, by getting reliable information at a time when the medical profession also has the information and can advise and can help explain what it means. When patients hear on TV or read in the headlines of newspapers some sensational story about some putative cure for a disease or some marvelous diagnostic technique that may or may not turn...
...Relman: Well, that's the risk. Under the present mode, the prevailing mode, the risk is that the doctor is going to do too much. Under the prepayment mode, the risk is that the doctor will not do enough. You have to start from the assumption that most doctors, the vast majority of doctors, are conscientious and are not going to do what is inappropriate and will not fail to do what is necessary. You have to start from that assumption. If you don't then health care is chaotic anyway...
...Relman: You're right in pointing out that on that one hand the total number of doctors were producing seems to be, by all criteria, adequate or maybe excessive but that the distribution of doctors inappropriate...It's a very tough problem. I don't think you can solve it simply by throwing more doctors as it, by producing more doctors in medical schools. The new doctors that you produce are going to go to the same places that the old doctors went. The fact is...where solid citizens don't want to live, doctors don't want live...
Crimson:How would you change the reimbursment program to save money? Relman: The fee system should be changed so that there is not such a high payment for technical procedures as compared with personal services. As it is now, a few minutes spent peering through the end of some sort of instrument...is reimbursed at a rate that may be literally an order or two of magnitude greater than time spent, talking to the patient, examing the patient, counselling the patient or staying up with a sick patient at a hospital. These kinds of personal services that require...
...Relman:In principle it sounds like a good idea...A big part of the reason that health care costs so much is that the insurance principle says "we will pay whatever the usual, customary charges are all we ask is that there be evidence that the procedure or test or treatment actually been carried out." If you have a bottomless well of money from the Federal Government and it's reimbursing costs of health care that way, even if there were no inflation...you would expect utilization to keep going up and up. And that's what happened. And what...