One way Health Maintenance Organizations (HMOs) contain medical costs is by making access to specialists more difficult.
To be sure, patients who rush off to exotic "ologists" at the first sniffle or pain drive up health expenses and insurance premiums. But two new studies suggest that specialists, for all their big fees and super-sophisticated equipment, do deliver better medicine.A Harvard Medical School survey of 1,211 doctors in New York and Texas finds that 94.1 percent of cardiologists are "very likely" to prescribe clot-breaking drugs within six hours of a patient's heart attack. Only 77.3 percent of family doctors are apt to do so, though secondary heart attacks are a clear danger.
The survey also shows that family doctors and internists are 25 percent less likely than heart specialists to put patients on drugs known as beta-blockers. Many general practitioners evidently aren't up on the literature that shows these pills improve the survival rate of heart-attack victims.
A Duke University study gathered similar findings. With less access to specialists and high-tech procedures, Canadians typically recover more slowly than Americans from heart attacks.
Though there is no evidence that survival rates differ, Canadian patients miss more work and suffer more post-attack pain than their U.S. peers. One more black eye for the oft-touted "Canadian system."
These studies imply two things. First, HMOs and similar organizations should refine policies that put up barriers between patients and specialized care: People who stay sick longer or have a relapse because they didn't get the best medicine are no bargain.
Second, family doctors must work harder to keep abreast of improved therapies - a tall order given the sheer number of medical fields.