Tuesday, November 27, 2012

Will the ACA increase waiting lines for patients?

Brad DeLong has a question on ACA implementation:
What is your guess as to what will happen if the ACA works for access, works for quality, works for coverage--but the extra health-care workforce needed isn't there, and the lines start to get longer?

I have two thoughts: 

First, to answer the question directly: looking at the issue from a market-based standpoint, if his scenario comes true, I think the obvious answer would be that we need to graduate more doctors.  Doctors make a ton of money, meaning that there is probably an undersupply (although there are probably additional reasons) and there are loads of people who would like to be doctors, but can't get into medical school because there are not enough spots.

The problem, in my opinion, is that a lot of healthcare seems supply-sensitive, rather than demand-sensitive.  Which is to say that the more available doctors or hospital beds, the more doctors will prescribe more treatment, despite the fact that a lot of this treatment has very little effect on overall health outcomes.  It's possible that lines will start to get longer as a result of the ACA's provisions on access, quality and coverage, but it's possible that demand-side is a less significant factor than we believe it will be.  If nothing else, the studies on supply-sensitive care suggest that training more doctors would result in a spike in healthcare costs.

A better solution, as my doctor friend Dylan notes, is to expand the Nurse Practitioner workforce: "Non-urgent medical screening can be handled by NPs, and physicians can see sicker patients. Many clinics already do this. There's no reason a doctor has to perform a screening pap-smear for example." 

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