New, No Interest Loans - From Your Doctor
Soon, mixed in with those continual mail offers for new credit cards, you might find a new kind of no interest loan being offered: one to cover that expensive piece of plastic surgery, cosmetic surgery, Lasik, or dental work you cannot afford out of pocket, and your insurance doesn't cover.
Eager to tap into a willing market of consumers who are already accustomed to credit card debt, more than 100,000 dentists and doctors are offering financing for patients customers who want services but cannot afford the upfront, out of pocket fees. And like most other credit card situations, the terms are attractive, as long as you don't miss a payment.
But directly involving a doctor with the financing of a patient's medical care, while perhaps a practical necessity in an era of low insurance coverage and high deductibles, seems to continue changing the doctor/patient relationship away from its traditional dynamic and towards one of consumerism, where a client finds a provider to perform services for a fee. The doctor moves from being a (hopefully trusted) adviser and partner in your healthcare to being the person willing to perform what it is you want done, a for-hire specialist.
And the for-hire is important to note; these no interest loans are only available to those with good to excellent credit. This means that the loans offer no help to those who most need it, the 47 million uninsured Americans whose difficult financial situations make them ineligible for the loans.
-Kelly Hills
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This is seems a bit too much nuanced...consumer, customer, patient, each has advantageous qualities in the right context. In a world that complains incessantly about financial barriers to "access", offering "no interest" financing helps. Problem is will it be co-opted to promote unnecessary care...probably will by some.
- by Stephen Gregg on Aug 31, 2007 at 9:44 AM | link
This fits right into the mentality of the many suburbanite families who are already up to their neck in debt. Mortgage payment, hummer payment, boat payment, credit card payments, heck what�s another $200 bucks a month to have that trophy wife or husband you�ve always wanted. And like you said, this is not helping the people who are actually without coverage and need it for critical treatment.
- by Cary on Aug 31, 2007 at 10:56 AM | link
Stephen - how do you see it providing access, when the article explicitly states that it does not provide access to those who need it the most?
It's providing access for those who already have it, but want more.
- by Kelly on Aug 31, 2007 at 9:07 PM | link
The docs that I know who are providing aesthetics are doing it for the profit, so that they can continue to provide the medical care that is *not* profitable.
There's nothing new, here. My husband and I only had major medical insurance until the early 90's. Since it didn't pay for routine maternity care, we paid over time for my pregnancy care ($300 in 1977, $1000 in 1982). I accepted the same sort of deal from patients. Major (necessary) surgery has been paid for by some patients over a period of time, for as long as I can remember.
- by Beverly Nuckols on Sep 2, 2007 at 10:51 PM | link
Why does medical care have to be paid up front? Is care "ethical" only when it's paid for by insurance companies or out-of-pocket up front?
Let's not make an issue out of something that isn't. Let people get their LASIK and pay for it later. Who's it hurting?
- by Matt W on Sep 3, 2007 at 11:12 PM | link
Matt - I admit I have a problem with a consumer driven model of medicine. And I have a problem with the idea of people taking out loans for medicine/going into debt to receive the care they need... especially if they're only able to do so because of their credit rating.
It smacks too much of deciding who deserves to have medical care and who does not.
- by Kelly on Sep 4, 2007 at 12:50 AM | link
So long as physicians are reimbursed on a fee-for-service basis, we will always have this quandary where physicians are caught in the middle of acting as their patient's advocates and as their own advocates. Moreover, until we restructure reimbursement to align physician and patient needs, this problem is going to persist. Unless we go to an all-capitation reimbursement plan or some other plan to limit expenditures, physicians will always make more money by treating their patients with more medicine. Physicians make money by practicing medicine, and I'm not surprised that doctors are rational economic creatures, even when their intentions are good. In one respect, this new treat-now-pay-later scheme is an improvement over the current reimbursement model: the patient is 100% cost-sensitive to the care they are receiving. Instead of having an HMO covered (or PPO, or Medicaid, or Medicare covered) cost-insensitive patient deciding how much care they should be receiving, the patient in this scenario is receiving 100% of the benefit from the treatment, and bearing 100% of the cost of treatment. At least there's not economic moral hazard here...
- by Matt W on Sep 4, 2007 at 7:11 AM | link
There's a lot of mixing "needed care" and things like "plastic surgery, cosmetic surgery, Lasik, or dental work you cannot afford out of pocket" on this thread.
I'm not at all sure what "restructure reimbursement to align physician and patient needs" means. But I've heard docs say that capitated systems "pay us not to see patients."
I think it was Pelligrino who suggested that the most ethical physician is one who is independently wealthy, and who only works because he or she wants to. That's why I buy a lotto ticket every so often.
Medicare and Medicaid seem to be designed to make us prove that really want to care for patients while meeting bureaucratic challenges and waiting to be reimbursed for at least some of the expenses we've already paid. And Medicare changes the rules as soon as we learn to make a profit on the old rules.
- by Beverly Nuckols on Sep 6, 2007 at 3:37 AM | link
Yeah, but do we really want to hold Medicaid/care up as examples of how things should work, or just how they do work right now? ;-)
Matt - you're right that this model leaves the patients very aware of the cost of their services... but is that a good thing? Maybe it is for non-medically necessary surgeries like cosmetic breast enhancement. But is it a good thing for medically necessary care? That, I become less sure about.
It seems the ideal might be some combination of socialized, basic, medically necessary care, augmented by a system like this, where those who can afford to pay for additional, non-medical but desired, services, can do so on their own accord - or own credit.
- by Kelly on Sep 6, 2007 at 11:20 PM | link
Their should be a legislative model where some part of government revenue should be allocated to general and special healthcare through state hospitals. I will gladly pay some chunk of my salary for such cause. This practice will prevent the economical losses incurred in case of any eventuality.
- by Navtej Kohli on Jan 8, 2008 at 5:15 AM | link