- Email: [email protected]
William G. Jones, MD
LETTERS TO THE EDITOR Ed Weber, DO
It is rare that I could take issue in the slightest with anything said or written by Bruce Hillman, MD. However, in his recent editorial “The Nonsystem of American Health Care,” there is a misleading statement that contributes to the problem. Hillman implies, as do so many others, that the delivery of health care in this country consumes 14% of the gross domestic product. If health care is defined as the work done to prevent, diagnose, and treat disease, then I doubt that we spend (as a wild guess) more than about 8% of the gross domestic product on those efforts. The 14% or 15% widely quoted is the sum of several economic activities: (1) providing health care, (2) the health care reimbursement and payment industry (insurance companies, health mainte-
nance organizations, etc.), (3) the health care administration industry (sometimes difficult to separate from item 2), and (unfortunately) (4) the health care litigation and malpractice insurance industries (and also additional parasitic but smaller industries, such as the new Health Insurance Portability and Accountability Act compliance industry). A summary of item 1 might include the costs of computed tomography scanners and pharmaceuticals; the salaries of nurses, physical therapists, and others; as well as the fees and salaries of physicians. But because significant percentages of the fees paid to physicians go to pay malpractice premiums, it could be argued that those dollars should be assigned to item 4. Likewise,
considering that many physicians’ offices now have large staffs needed to deal with a byzantine reimbursement system, the costs of those staffs might fairly be subtracted from item 1 and placed in item 2. Such analysis of costs would be hotly debated, but even with compromises, I doubt that it could be shown the cost of actually providing health care (after excluding the parasitic activities) is more than about 8% of the gross domestic product. It is in the interest of the medical community to constantly point out that no effective solution to the “high cost of medical care” is possible without first getting careful answers to a basic question: “Where does the socalled health care dollar go?” It sure doesn’t all go to health care.
Ed Weber, DO, The Imaging Center, 7631 W. Jefferson Blvd., Fort Wayne, IN 46804; e-mail: [email protected]. DOI 10.1016/j.jacr.2004.04.012
William G. Jones, MD
In the April issue of JACR [1], Dr. Bradley has written a concise detailed history of the evolution of radiology call over the last 20 years and he makes a good case for teleradiology as it can be practiced today, free from constraints of time and place. If not already the case, soon it will be the national standard of care to provide interpretations 24/7 to everyone.
From my perspective as a teleradiologist for the last 6 years, there is another aspect to teleradiology that Dr. Bradley did not discuss. By installing DSL and T1 lines into my home office I have been able to practice teleradiology in a most comfortable environment. It is true that I am awake the nights I am scheduled to work, but when not working, I have not had to
leave my community, family, and friends. I wonder how many US born radiologists will be willing to work for 6 years far from home, even in a location as pleasant as Zurich or Sydney.
REFERENCES 1. Bradley WG. Offshore teleradiology. JACR 2004;1:244-248.
William G. Jones, MD, 2344 Prince Albert Drive, Riverside, CA 92507; e-mail: [email protected]. DOI 10.1016/j.jacr.2004.04.017
442
© 2004 American College of Radiology 0091-2182/04/$30.00
It is rare that I could take issue in the slightest with anything said or written by Bruce Hillman, MD. However, in his recent editorial “The Nonsystem of American Health Care,” there is a misleading statement that contributes to the problem. Hillman implies, as do so many others, that the delivery of health care in this country consumes 14% of the gross domestic product. If health care is defined as the work done to prevent, diagnose, and treat disease, then I doubt that we spend (as a wild guess) more than about 8% of the gross domestic product on those efforts. The 14% or 15% widely quoted is the sum of several economic activities: (1) providing health care, (2) the health care reimbursement and payment industry (insurance companies, health mainte-
nance organizations, etc.), (3) the health care administration industry (sometimes difficult to separate from item 2), and (unfortunately) (4) the health care litigation and malpractice insurance industries (and also additional parasitic but smaller industries, such as the new Health Insurance Portability and Accountability Act compliance industry). A summary of item 1 might include the costs of computed tomography scanners and pharmaceuticals; the salaries of nurses, physical therapists, and others; as well as the fees and salaries of physicians. But because significant percentages of the fees paid to physicians go to pay malpractice premiums, it could be argued that those dollars should be assigned to item 4. Likewise,
considering that many physicians’ offices now have large staffs needed to deal with a byzantine reimbursement system, the costs of those staffs might fairly be subtracted from item 1 and placed in item 2. Such analysis of costs would be hotly debated, but even with compromises, I doubt that it could be shown the cost of actually providing health care (after excluding the parasitic activities) is more than about 8% of the gross domestic product. It is in the interest of the medical community to constantly point out that no effective solution to the “high cost of medical care” is possible without first getting careful answers to a basic question: “Where does the socalled health care dollar go?” It sure doesn’t all go to health care.
Ed Weber, DO, The Imaging Center, 7631 W. Jefferson Blvd., Fort Wayne, IN 46804; e-mail: [email protected]. DOI 10.1016/j.jacr.2004.04.012
William G. Jones, MD
In the April issue of JACR [1], Dr. Bradley has written a concise detailed history of the evolution of radiology call over the last 20 years and he makes a good case for teleradiology as it can be practiced today, free from constraints of time and place. If not already the case, soon it will be the national standard of care to provide interpretations 24/7 to everyone.
From my perspective as a teleradiologist for the last 6 years, there is another aspect to teleradiology that Dr. Bradley did not discuss. By installing DSL and T1 lines into my home office I have been able to practice teleradiology in a most comfortable environment. It is true that I am awake the nights I am scheduled to work, but when not working, I have not had to
leave my community, family, and friends. I wonder how many US born radiologists will be willing to work for 6 years far from home, even in a location as pleasant as Zurich or Sydney.
REFERENCES 1. Bradley WG. Offshore teleradiology. JACR 2004;1:244-248.
William G. Jones, MD, 2344 Prince Albert Drive, Riverside, CA 92507; e-mail: [email protected]. DOI 10.1016/j.jacr.2004.04.017
442
© 2004 American College of Radiology 0091-2182/04/$30.00