Thursday, September 6, 2007

More on healthcare issues

So I wrote about the incredible burden of complex bureaucracies on the US healthcare system here, well, here's a really cool piece from Slate about same-day appointments at family doctor practices, something called an 'open access' model. There are huge difficulties in setting up such a system, not the least of which is the process of actually switching over from your appointment system. Another big issue:
Doctors also have to make sure their practices don't take on more patients than they can handle. The total number of patients in a practice, called the panel size, is crucial because it determines the demand for service on a typical day. Obviously, the larger the panel, the higher the number of expected daily appointments, and if demand outstrips supply, waits are inevitable. Yet many doctors have no idea whether their panel size is too large. They track only the patients they see, not the patients who wanted an appointment but didn't get one. That's a formula for underestimating actual demand for service.
Sound like we need more business and economics in medical schools.?..come on people!! Every time I mention this to someone in healthcare, or med school, they tend to enthusiastically agree. Anyway, luckily (or not) some academics are on the case!
Taking into account the total number of appointment requests is the first step to open access, but it doesn't do the trick on its own. It seems like common sense to balance the number of daily appointment slots with the average daily number of appointment requests. But a mathematical model built by operations researchers at Columbia University shows this intuition to be wrong.
Interesting. So I checked out the article, it's published online because they want to make the results as freely available as possible. In fact, they even have a spreadsheet where docs can enter variables about their practice size to get assistance on operating an open access practice. They summarize the above situation in a different way, and I think a little better:
A fundamental feature of patient demand for primary care
is its random nature: the actual number of patients
requesting care on any particular day will vary around the
average daily value, sometimes substantially. It is this
inherent randomness that makes it difficult to determine
the answers to questions such as: “How large a panel size
can be served by a given physician practice?” If not for this
variability in demand, the answer would be obvious—the
panel size would be the one that made the daily demand
for care equal to the daily number of physician appointment
slots available. However, with this variability, making supply and demand equal on average would create chronic backlogs for care and waits for appointments that would likely get longer and longer.
Really, really interesting. I'm looking for a doctor, I need to find me an open access doc, that would be awesome.

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