Highways and Medicare - Supply Creates Demand

Health reformers risk forgetting the Field of Dreams fallacy as they wrestle with the question of whether our flawed medical delivery system is fueled by undersupply or overdemand.  Some within the Obama administration fear we have too few physicians, particularly in the primary care area.

But one thing we know about medicine is that supply generally drives demand, a relationship that's been proven repeatedly by Dartmouth researchers.  Government data shows that the region with the highest health costs just happens to be the one where people visit the doctor more often without any improvement in health status.  They just confront bigger bills.

This doesn't suggest that people don't face uncomfortably long waits for appointments with primary care physicians; although there's little evidence these delays are dangerously long.   The analysts are probably correct that this problem could be solved by educating more primary care physicians. 

But there are other possibilities, including computerized diagnostics that help patients decide when they really need to see a doctor, and more walk-in clinics that promise a quick response to common problems. 

Indeed, an argument can be made that the system would be more efficient by a strategy that made it more difficult for some people to see a doctor (self-referral to specialists isn't a good idea), teamed with options that made a quick physician consult (via email or telephone easier) and a larger number of clinics staffed by physicians assistants or nurses, who tend to know more than most of us, often know how to ease our pain and should know when our problems overwhelm their competence and require referral to a physician.

America's cities spent billions on freeway construction before there was a belated realization that if you build the roads, the cars will quickly follow.  New York saw that during the Robert Moses years, but failed to acknowledge the logic until a few decades later.  Those in the energy and environment areas are better able to describe the substantial collateral damage better than I can.

One possible lesson is that if you make Biloxi look like Boston in terms of the ratio between physicians and population, the result will increase costs without improving care. Adding to the physician supply is not unlike building more freeway lanes.  It is expensive and takes a long time before you begin to see the results, which offer nothing more than temporary relief and a big hangover.