25.1.08

Living Healthy - In Holland & Elsewhere

After my Guitar Hero Healthcare post, a reader named Chloe left a great comment.

Chloe takes me to task about how difficult it will be to constructively channel the self-interest of the 'me' generation into positive changes (rather than destructive demands) that induce physicians to offer specialized services and customized patient interactions.

Meaning, if we want customized interactions - we'll have to pay for them.

The bottom line is this - if we want healthier people we have to build a system that provides incentives to docs and incentives to consumers.

Meaning, we first have to pay PCPs and GPs in a manner that properly recompenses them for the vital services they currently provide, including managing expectations and acting as gatekeepers for the system.

Meaning, if we want additional PCPs to enter the field, we have to provide more incentives. Meaning, we have to provide them with more benefits.

Meaning, if consumers want customized services that take more time and may decrease volume, we have to offer them, and we have to pay docs MORE. Meaning, we have to respect and respond to PCP concerns about quality of life and work arrangements.

Now, docs can hold their breaths until they're blue in the face waiting for someone to do something about the situation and up reimbursements (CMS? HMOs? Govt?).

Or, docs can take a deep breath and decide to offer services that people are willing to pay more to receive.

If you're a PCP, the fundamental economic question is this: At what level can I substitute the value of individual services for the volume I must currently maintain to make a living wage? And will operating at this level bring some joy and job satisfaction back to practicing the art and science of primary care services?

Do the CBA for yourself.


If you decide to offer customized services, you'll need to ask the following basic brainstorming questions:

  • What services should I offer?
  • What do I need to charge per patient per service?
  • How does my scheduling change as a result of offering personalized medical services?
  • How does my billing/accounting/budgeting change?
  • Why am I interested in offering personalized medicine?
  • What benefits do I expect to gain from modifying the fundamental structure and vision of my practice?

Docs are an intelligent, highly-trained bunch offering expert services. I don't see many of them hanging around waiting for someone to up reimbursements - I see them leaving the field instead.

We're not paying them enough to stay in the game. They're not thinking about creative ways to make enough to stay in the game - they're too busy trying to heal people in 4-8 minute windows.

The new healthcare marketplace is a hybrid of services - a mix of wants and needs. Services you tell us we need and services we tell you we want.

Docs can design payment plans and combo menus of services that mimic formats consumers are familiar with using.

Let's take emailing your PCP as an example.

  • Docs could require we pay up front for 10 emails/month a la the Blockbuster plan, or pay per email a la the ITunes a la carte menu.
  • Please note I'm talking about paying MORE for access to the doc's knowledge here, not asking for a massage while I wait to be weighed in.

So yes, Chloe, in response to your excellent comment, I do believe enough of us will pay to have docs spend primary time on our individual care, advising us at a personal level what we can do to improve our health. I believe we don't have much other choice.

  • I believe our insurance companies and our government are already playing with switching the burden of payment to us, via FSAs and HSAs, via requirements that we have health insurance coverage, etc.
  • I believe that even if we end up with a government-funded federal healthcare system, a subterranean 'black market' for individually paid personal services will thrive.

Why? We won't wait 6 months for a knee-replacement. Remember, the global healthcare market is a hybrid of wants (services provided in a timeline we want) and needs (services docs tell us we need and arrange to provide).

I believe we pay for services we need (electricity, water) and we pay for services we want (cell phone service, high-speed internet).

I believe the healthcare market is waiting for all of us (providers, payers, docs, hospitals, insurers, policymakers) to catch up to the idea that in the hospital/healthcare/wellness management basket of goods there are both services we need (emergency care, L&D, trauma) and services we want (discretionary plastics, fertility treatments, dermatology, concierge care/telemedicine).

And yes, I'd pay more to be able to email my doc (although not at 3am - during office hours is fine). I wouldn't mind paying a fee per email, in fact. I wouldn't mind waiting 72 hours for a response. I wouldn't mind paying double the rate for a response within 24 hours.

I'd pay much more to be able to visit in the evening for my annual physical (or on a Saturday morning).

I'd pay out of pocket to have 20 uninterrupted minutes to sit down with my PCP and go over my SHMP (self health management program) and hear her recommendations.

Maybe a doc-blogger can figure out according to CMS/UnitedHealthcare rates how much that 20 mins would cost me? (And add another 1o to type/print out an Rx of recommendations).

And speaking of an SHMP, rather than try to outline what works for an entire generation of new healthcare consumers and providers, I'll share what works for me.


Below are two of my not-so-secret weapons for self-health management.


I don't yet have a GP here in The Netherlands, but when I do, I will share these activities and ask for recommendations on how to improve my health.

This being Holland, the land common sense has not forgot, the doc will most likely look at me like I'm completely gonzo.

Will these two factors ensure I stay healthy? Of course not. They don't completely negate genetic predispositions (such as high cholesterol) or offset my tendency to drink too much java.

But they're two daily choices I consciously make to maintain a fit and active lifestyle.

  • First, my fiets.


I'm now the proud owner of a well-broken in Gazelle (you don't want to buy a new bike unless you keep it indoors as there's a thriving stolen bike trade) - yesterday I took off for my inaugural ride.

This will be my commuting vehicle.

Rides to and from work should take between 40-60 mins depending on the 'traffic' in bike lanes and the weather, as well as my tolerance for weaving in and out of mopeds and other cyclists on the way to work/school.



I drink at least two of these little blended fruit shots a day - they're strangely addictive and contain a full serving of fruit. I can't believe Knorr (Unilever) hasn't made them available in the States yet.

The company does limited edition seasonal fruit/veggie mixes - I'm currently loving the winter fruit (apple, pear, pumpkin). A four-pack goes for about 1.99E, and some grocery stores sell 12 packs.

Sometimes I mix them with an orange-flavored tablet of Vitamin C (1,000mg) and sparkling water, and sometimes I take the hit plain.

Other healthcare bloggers are writing about what they do to maintain desired levels of health and wellness.

Happy Hospitalist writes here about his top-secret healthy juice.

Life as a Healthcare CIO John Halamka writes here about his vegan Thanksgiving.

Normally I don't tag, but I'd love to see what some more writers keep in their secret wellness weapons arsenals.

I hereby tag 3 other healthcare bloggers to share two of their personal solutions to self-health management.

Emergency Em, The Physician Executive, and WhiteCoat...consider yourselves tagged!


2 comments:

WhiteCoat said...

OK here are my health habits
First, exercise when I can. Taekwondo 3 times a week plus stair machine and Soloflex in basement. I also run the stairs at the hospital. No elevator.
Second, diet. I rarely eat red meat. Fish, legumes are my favorites. I like dairy products, too, but try to stay away from them. Drink lots of flavored water and Gatorade.
Third, supplements. I don't believe a lot in vitamins, but I still take a multivitamin, s-AME, and Stacker a few times a week.
Last, checkups. I've been bad lately, but I still have all my labs checked every year.
I can't say that I'm the epitome of health, but I can still outwrestle the kids (so far).

Zagreus Ammon said...

No insights or secrets from me, I'm afraid. I am still trying to get off my keester, as the snow has kept me off my bike and my new job has kept me out of the gym. Honestly, I do a better job intervening on behalf of my practitioner's health than my own.

As Happy does, I take a supplement, assuming that occasionally I do not consume a sufficiently balanced diet. I am over 40 so I take an ASA daily. This is the most underused well-documented preventive intervention a man can benefit from (but data muddier for women.)