A Proposal on The Bill on Doctor's Self Referral System in The Private Medical Care Sector

In the business world especially the Medicare system, there are many rules and regulations that the sector must go through in order to succeed. There must be someone to fight against the rules that seem to inhibit the prosperity of private healthcare sectors. Some of these rules are the ones associated with the physicians self referral system. In a place where new rules are being drafted, suggestions can be made depending on the changes that need to be done. In my country, state self referral prohibitions do not exist. As they were being drafted by my boss Congresswoman Starkey, I chose to make suggestions on what the draft should at least capture physician self referral act is where a physician working in a certain medical centre refers a patient to another healthcare centre where he has self interest

Physicians self referral prohibitions will tend to prohibit physicians who have a personal Medicare centre or have a family member owning a Medicare from referring patients to the same centre. The rules should prohibit a physician self referral if the physician expects to gain financially from this. The rules should also prohibit Medicare centers to receive services that are substandard or the person who will attend to the patient is not qualified. The regulations should also be against unfair market values in terms of price of the services delivered. The rules should require compensations if any to be made without considering the volume of referrals made by one party to the other. The rules should be against physicians who refer patients to certain Medicare centers with bad intentions. Breaking of these rules should be penalized through fines and other sorts of penalties. These rules would then prevent a few things which includes;

Extra cost-When one is referred by a physician to a certain health centre, most of these centers are costly than the usual Medicare facilities. They tend to charge almost every service that they provide. Some of these services might be provided for free by the other health centers. Then, such centers have complicated and long procedures that tie the patient to them when accessing the service. Therefore, banning of physicians self referral system is important in that it prevents the exploitation of the patients by physicians with self interests.

Attendance by unqualified personnel-Most of these centers where one can be referred to provide limited services. This is due to the fact that most of them lack the qualified personnel as well as the medical facilities that are important in providing the required standard services. When one is referred to such a health centre, they usually find that the services they want might be there but are of law quality or only a portion of these services are provided. For example, a person with cancer might be referred to a medical centre where they offer the usual drug prescription services with nothing more special. Services like chemotherapy might not be available which means that the patient will have to go to another hospital if he or she requires chemotherapy.

Self gain- The essence of referring the patient to such a health centre by a physician was to just get the portion of money that the patient had and then let them move on to the other centers where the required services are provided. This makes it a form of inhuman business where the physician is only interested in the profit that will be made from treating such a person but the life of the person does not matter so much to him. Prohibiting a physicians self referral system is important in that such instances where the profit oriented physicians exploit the patients are prevented. If the activity is banned, the patients can be referred to a medical centre where he can get the services he requires and deserves.

Overutilization of resources and services- Elimination and prevention of a self referral system ensures that there is no overutilization of facilities and services. This is because for such a medical centre to attract more patients, several unnecessary incentives are provided to lure the patients. Continued provision of unnecessary incentives stretches the services and the resources that are available due to their overuse. Provision of such incentives also makes use of a lot of labor that could have been managed or used better if such unnecessary services were not available. Overutilization also may be in the form of prescribing several tests that may not be of so much essence. For example, the civil servants whose medical care burden is placed on the government may be provided with services that are of no essence. This therefore leaves the government to compensate for a large amount of money that could have been avoided if the patient received medication in a normal health centre thus banning of physicians self referral act prevents overutilization of services and facilities.

Market imbalance- Physicians -self referral system also brings an imbalance in the market where the physicians tend to refer the patients who are more profitable to the hospitals and medical centers of their interest. When these patients get to such medical centers, they are made to pass through systems and procedures that have higher reimbursement. If this happens in an economy, the other hospitals are unable to compensate for the losses they make in provision of basic services to the patients. Other medical facilities tend to operate by making little or no profits that burdens them so much. This is because these high interest patients are the ones that compensate for what may have been lost when providing essential and relevant services that may not be earning them anything.

A good example is an instance of outbreak of a disease. The medical centers that are not referred to maybe on the forefront to provide medical care to the patients that have been affected by the outbreak in order to curb the disease. At such a time, such a medical facility may incur a lot of expenses that may bring about losses. If the high profit patients are kept away from these hospitals then they will never be able to compensate for the losses they make. This in return creates an unnecessary and unhealthy competition. All this can be prevented if the physicians self referral system was banned.

Various provisions can be made on the matter which ensures that the patients are not exploited. There should be a refund of the amount collected by the facility against the physicians self referral system. The act would ensure that patients pay for a service that is equivalent to the payments they make. A few services that are provided due to the essence of earning more income will be eliminated since they do not serve any purpose whatsoever. This also would reduce the unhealthy competition since every medical facility would be getting the share it deserves for high revenue patients.

When a medical facility goes against the stipulated laws, it should be excluded from the provision of some services. This serves as a lesson to it and the other similar facilities that tend to make profits from the exploitation of patients. It also ensures that the unessential services that incur extra cost are scrubbed off leaving it with the essential services that keep it alive. The facilities that have similar services that act on substandard bases will then be forced to improve them so that they can be earning profits from quality services in stock

If any of these medical facilities or a physician goes against the stipulated rules then both of them should be fined. The fines should then compensate for the revenue that the government will have lost to the hospitals private owners. This fine also serves as a warning to the other facilities that operate in a similar manner. Through this, physicians will self interests will refrain from referring patients to medical centers where they earn interest or share profits.

If the measures that bar physicians from referring patients to certain medical centers are followed then instances of patients exploitation would reduce. People would be receiving the appropriate medical care in the appropriate medical centers. Extra costs would not be incurred and unhealthy competition in the market would subside. The three measures are important because they serve people the best and that they are the main measures that can be taken against such instances. Other inferior measures would not serve to eliminate such instances as required.