What’s keeping us out of the doctor’s office and waiting in line?

 Americans have gotten used to getting what they want quickly and conveniently. We stream movies “On Demand,” do banking from home and can order just about anything online to be shipped directly to our doorsteps within days. Why, then, is getting access to doctors—one of the most essential services for health and wellbeing—so difficult?

While advances in some industries have revolutionized the way we shop and consume, government policies that have reduced economic freedom in the health care marketplace constrain our health care system, impeding access to treatment and innovations in care. Even in major metropolitan areas with high physician to population ratios, Americans can end up waiting an average of 20.3 days for a new-patient appointment with a family practice doctor. Appointments can be even harder to schedule outside of normal business hours. When asked, 66 percent of U.S. patients said “they found it somewhat or very difficult to get care in the evenings, on weekends, or on holidays.”

 

Why you have to wait

Years of government interventions in health care markets have distorted the supply and demand of care. Here are a few reasons why you have to wait, and wait and wait …. and why it’s about to get worse:

• Congress distorts the number of doctors: Unlike engineers, bankers or musicians, the number of practicing doctors is a political decision heavily influenced by the profession itself. Until 2005, physicians predicted a surplus of doctors and, according to Harvard University medical professor David Blumenthal, author of a New England Journal of Medicine article on the doctor supply, physicians encouraged Congress to limit funding for residencies and new physician graduates.  But, by 2005 industry groups representing doctors were warning of an impending shortage. Instead of letting market forces respond to society’s demand for doctors, physicians and government representatives still mistakenly try to plan the “optimal” number of doctors.

• You might have government health care: Government programs—namely Medicaid and Medicare—reimburse doctors at a lower rate than private insurance companies, take longer to send payments and require complicated billing rules and paperwork. As a result, doctors are less likely to accept new Medicaid and new Medicare patients. Unfortunately, having government-run health care makes accessing a doctor’s appointment even more difficult for some of the least well-off.

• Licensing requirements limit alternatives: Industry groups representing different health occupations influence health worker licensing requirements to limit alternatives to a standard doctor’s visit. Stricter requirements reduce competition in the health care market, causing longer wait times for sick customers. For example, until 2007, the American Medical Association called for a total ban on retail clinics like CVS®’ MinuteClinic®,  Target Clinic® and the Clinic at Wal-Mart, which are usually staffed by nurse practitioners.  Recognizing the bottle necks created by strict licensing, other groups including the RAND Corporation and the Institute for Medicine have recommended changing regulations and “expanding the roles of health professionals beyond the traditional scope of practice” to help break delays that exist in accessing primary care.

 

Why it’s about to get worse

The Affordable Care Act of 2009 (ACA) may create a surge in demand for doctors that will make face time with a doctor even more expensive and difficult to find than it is today.  For evidence, look at Massachusetts—a state that passed similar legislation in 2006. When Massachusetts used its health care bill to cover 430,000 previously uninsured residents, visits to emergency care wards ballooned, in part, because it became even harder to access doctors.

According to the Massachusetts Medical Society, the average wait time expected for any Massachusetts resident seeking a new appointment with an internist increased by more than 50 percent from 2006 to 2007, increasing from 33 days to 52 days. By 2011, only half of internists (47 percent) surveyed said they were taking new patients, and in the worst counties, individuals who find a doctor willing to take new patients can expect to wait an average of 118 days.

Adding to the burden of rising doctor demand are the long-term health care needs of America’s aging population.  According to Administration on Aging, by 2040, more than one in four Americans will be over the age of 60 compared to just one in six in 1990. And, as the baby boomers enter into retirement ages, their likelihood of developing a chronic condition such as diabetes or heart disease increases—meaning greater need for medical care and more demand on the health care system in the future.

 

Time for a cure   

While centralized decision-making and regulations that prevent competition have created access problems in the health care marketplace, exciting innovations are developing in areas that remain relatively free—at least for now. For example, in the first 10 years after their invention, retail clinics expanded to more than 730 stores in 37 states granting patients quick access to any number of basic health services, ranging from a basic flu shot to diabetes monitoring.

Additionally, in response to customer demands for better care, some doctors are creating new care models that offer longer visits and 24-hour availability for a monthly fee. Although these new doctor-patient models are expanding quickly and provide services to more than 100,000 patients in 24 states, future growth is constrained by federal and state laws that make it difficult for doctors to contract directly with patients.

Greater economic freedom allows innovators to respond to consumers demanding shorter wait times and more responsive service in health care. By developing new alternatives to the standard doctor’s visit, entrepreneurs may encourage doctors to take steps to better meet  the needs of their patients.

More economic freedom may not instantly cure all that ails our health care system, but it is certainly the right treatment.