Saturday, April 18, 2009

Goodbye Pediatrician, Hello Real World.

Last week I went to see my pediatrician and it was perhaps my last visit to her office. Apparently, once I graduate from college, I am no longer eligible to see my pediatrician. I am a little sad because I think, "what general practitioner can possibly care as much about me as my pediatrician?!"

On that note, I have decided to post some things from Health Econ that I thought might be helpful for those of you who will be entering the real world.

Fee-for-service is pretty obsolete now, but it's what your parents might be familiar with. The U.S. has moved towards managed care to contain costs. Thus, we have HMOs and PPOs.

Story: Professor McKnight's friend cut his finger once and went to the emergency room that was closest to him. However, the ER told him that it was not life threatening and that he would have to go to an ER about 40 minutes away to be covered by his Staff HMO. He took a cab to that ER, and they said, "well, you needed stitches, but it's been so long now, that you might as well come back tomorrow."

If you think you would be really upset in this sort of situation, go with the PPO.
But don't worry, HMOs cannot deny emergency care in life-threatening situations.

For network and staff HMOs, you must receive referrals in order to see specialists. For example, you can't see a cardiologist unless your primary care physician gives you a referral.
Also, certain HMOs only cover you in a specific state or region, so you might have to switch to a PPO if you end up moving or traveling.

The difference between network and staff HMOs:
Network HMOs pay physicians through "capitated reimbursement" - fixed fee per patient over a certain period of time.
Staff HMOs pay their physicians a set salary regardless of the number of patients they receive.
Staff HMOs also have their own physicians, clinics and facilities.

Looking at all of this makes me wish I could just see my pediatrician forever, like Ross Geller on FRIENDS...

In other news: Jason Kubel of the Minnesota Twins hit for the cycle. And I got to see it with Evs while eating sushi in Boston last night!


  1. i don't want to leave my pediatrician either! what are upsides of HMOs?

  2. they're cheaper. haha. sorry, i've been brainwashed by my dad and brother b/c they really hate HMOs. most doctors do...

  3. i'm glad i left my pediatrician. it's so much harder to talk about ...other things... when i know that my pediatrician can adn will just as easily tell my parents!