Pay for appearance

Pay for appearanceAn aging population, stagnant population of physicians, and increased use of medical services are making it harder for patients --especially older people-- to find and keep physicians. Health plans can do what they want to try to change physician behavior, but there's enough demand out there that even lousy docs shouldn't have a hard time keeping their panels full in the future, if they want.The Wall St. Journal, in its Journal Report, describes some good strategies to help older people find and keep good physicians (Is There a Doctor in the House?):

• Retire to a place with good Medicare reimbursement so docs will be drawn there and stick around. If Medicare reimbursement isn't so hot, move before qualifying for Medicare and start life with the doc on private insurance. (Not sure how practical that part is.)
• Think like a salesman --finding a way to pitch yourself as an attractive patient
• Hire a lobbyist --a geriatic care manager who can advocate and coordinate
• Seek alternative settings for treatment, e.g., clinics. This I think will be a big outlet in the coming years.
• Work with a pharmacist --either at the local drug store or by hiring one to work with you
• Try out disease management --by enrolling in Medicare managed care or asking your health plan
• Join a support group --to meet other people dealing with the same BS
• DIY --learn more about how to take care of yourself

The article adds with one of my favorite ideas (see Why not pay Granny to take a hike?): "Move offshore."

It might sound extreme, but some retirees are moving to Costa Rica, Mexico and other countries where health-care costs are appreciably lower and the quality of service, they say, is significantly better...Mr. Preston started thinking about pursuing care for his father in another country. He settled on Costa Rica after a friend returned from a trip there, singing the praises of the country's medical services. Eventually, Mr. Preston's father settled in a private home in Costa Rica, with a house manager, chauffeur and three attendants -- all for about $3,000 a month. Instead of being confined to a nursing home, his father attended church every Sunday, took a large group to brunch afterward, went out to dinner several times a week -- and occasionally even went on a date. (Mr. Preston flew down to see his father once a month on a four-hour flight to San Jose, rather than a three-hour flight to Florida.)"In Costa Rica, the medical system is excellent. My father's doctor there would call me up in Connecticut," Mr. Preston says. "I couldn't get doctors in Florida to return my phone calls."