Having practiced medicine for more than half a century, I have observed some major trends that have made many services less accessible without contributing anything to the quality of care. Although various rationales are put forward for changes, the truth is that financial motives underlie most. Some of these problems are due to the reorganization of medicine in the Health Care Industry model. Medicine does not lend itself to the assembly line approach which is the way that most administrators would like to reconfigure it. Guidelines, which are merely that, and not rules of treatment, may have their place, but woe betide the physician, whatever his knowledge or experience, who deviates from them. The administration strives to control the standard of care and seeks a baseline minimal standard. They are as critical of physicians who exceeds those standards as they are of those who fail to meet them. (Except when they themselves are ill!) They strive to structure the fee schedule to engineer the system the way they think it should be. They strongly endorse electronic records not because it is in the best interests of patient care, but because it gives them more control. The trouble is, that they themselves don't understand the true nature of quality in health care.
An example of the detrimental effect that fee scheduling may have is as follows. For many years I gave intra-articular (into the joint) injections for patients with severe arthritis. I can't remember exactly what I was paid for this, but it was considerably under $20. It was quick effective easy management for the patient. It avoided the inconvenience of extra visits. I never had a single complication. Now with the various capitation systems of payment (the Dr. is paid on the basis of the number of patients in his practice), there is no fee for the injection. So, what do you think happens? Well, this procedure falls into the specialty of orthopedics. So, most physicians and particularly younger ones, don't bother to spend the time and effort in mastering the technique and refer the patient to orthopedics. Unfortunately, it takes months to get a consultation and of course it costs many times what it did when done in the GP's office. Most egregious of all is the inconvenience and suffering and perhaps absence from work, that the patient is subjected to that no one seems to consider at all. This is merely one example of a situation which squanders our health care resources.
Comment if you have any views on this.