I agree. This is a sign that health care is in the process of fixing itself.

If you have 45 minutes to kill, you can listen here (http://dpcare.org/wa_health_underwriters) to a Seattle doctor talk about the issues, his company's approach, and why direct primary care is such a good thing. He advocates concierge care as opposed to the Walmart care discussed in the article, and I find the approach to be more sound. His approach is like Performace Based Logistics for medicine--the doctor that keeps you healthier makes more money, and I like that incentive. Nonetheless, both his solution and the Walmart solution are attempts at taking advantage of the same idea: paying directly for primary care can both lower costs and improve quality because the time and money required to pay for routine things with insurance is so terribly high.

I am convinced we are witnessing the birth of a revolution in medical care. I pay out of pocket for primary care, even though my insurance would cover everything if I went to a traditional provider. The new way is that much better than the old way -- and that cheap.

Great, thank you for that link. I look forward to listening to him during breakfast tomorrow.

I agree that concierge practices sound like a better approach, at least as a primary source for health care. It would be the same as insurance for the smaller things. Leaving insurance to cover larger things. As far as I can tell the worst of the problem is caused by insurances and the related need for medical billers. Another interesting group are the Ideal Medical Practice Doctors. They work with minimal staff and use cheaper technology so they can lower the cost per patient and spend more time with the patients. One doctor I have heard has zero staff.

A free marketplace is absolutely crucial to fixing healthcare. The consumers (patients) have to be at the center of the entire system. When you give the consumers the money, they will make informed decisions. This will lead to physicians providing better service for lower costs. That is why this model works so well. Nice video.

(If the doctor that keeps you healthier makes you more money, will that not drive doctors to less risky specializations? I'd imagine that a brain surgeon for example sees many more people who are likely to die than say a dermatologist.)

There was a study a long while back, I think I read it in the mid 90s, that the best doctors and hospitals had lower recovery rates, because they took the worst, most difficult, cases. I saw it as part of a discussion of the difficulty of rating health care service providers.

How about this for an incentive: The person who keeps himself healthier, reaps the rewards of a healthier life.

What I'm wondering is how much these clinics use technology and how much better they could be if they used it more.

I wonder if having a small number of doctors available to these nurses could improve treatment by allowing more patients to get a doctors opinion (somewhat in the same way e-mail and IM tech support allows each technician to server more people than phone support). Could they treat even more conditions that way?

It seems a setup like this with some technology checks and balances (to make sure the right questions get asked) could make health care a lot more efficient.

Generally speaking, PAs and NPs must technically be "supervised" by a physician. I think the degree of supervision varies by state, but it's typically not case-by-case supervision - rather more of a general sign-off sort of thing, with availability for the "tough cases". That sort of sounds like what you're describing, though obviously there's a wide spectrum of how involved the doctor can get.

Walmart has a deal with RediClinic. The Walmart RediClinics are apparently using eClinicalWorks, the rest might be Athena Health. I expect these clinics use technology as much as possible. I don't think they can lower cost much more by using more, and if they did I expect any profits would be kept with no change in price.

http://ecwblog.blogspot.com/2008/02/walmart-rediclinic-eclin...

http://www.redorbit.com/news/health/1501613/rediclinic_to_le...