Do Immigrants Help or Hurt US Healthcare?

Nicholas Genes, MD, PhD


May 13, 2008

Immigration is a hot topic these days, and its impact on the US healthcare system has been studied and debated from various angles. So it's not surprising that healthcare entrepreneur and business consultant David E. Williams has weighed in on the issue. But you might be surprised at his particular views.

Mr. Williams is a consummate writer on business issues in medicine. The first time we profiled him, he discussed why he started the Health Business Blog and how he used the Web site to promote interest in his consulting firm, MedPharma Partners. In a later column, he described his new blog that covers the nascent field of medical tourism.

Mr. Williams' work keeps him at the forefront of the business of medicine. For instance, in early May, Mr. Williams traveled to Las Vegas to moderate a session at the Consumer Health World conference, where he interviewed leaders of prominent healthcare organizations. And then there is the issue of immigration. In one recent post, he commented on a study that examined immigration from a somewhat unusual perspective:

Quite a bit of the anti-immigration fervor has focused on how immigrants (legal and illegal) put a strain on the health care system. While I'm sympathetic to the specific communities where this occurs, it's worth noting that when it comes to health care overall, immigrants provide a lot more than they receive. (That's something that's been documented.) Those who want to keep immigrants out should be prepared to wait longer to see a doctor and lose the chance to consult with their pharmacist.

Ironically, the only real beneficiaries of anti-immigration policies for health care workers are the home countries of those workers who would ... otherwise be in the US. We need to make the US more hospitable to health care immigrants rather than less.

David E. Williams at Health Business Blog hosts Grand Rounds
May 13, 2008

In another post, Mr. Williams discussed physician payments and rising healthcare costs in response to Jonathan Kellerman's article "Health Insurance Mafia" in the Wall Street Journal:

Kellerman thinks the answer to health care costs is to shift back to paying for physician fees and hospital stays out of pocket. But the example he offers from his own experience hints at the fallacy of his position.

Several years ago, I suffered a sports injury that necessitated an MRI. The "fee" for a 20-minute procedure was over $3,000. My insurance company refused to pay, so I informed the radiologist that I'd be footing the bill myself. Immediately, the "fee" was cut by two thirds. And the doctor was tickled to get it.
All we know about his encounter comes from those few sentences, but there are some things about it that don't smell right:

If the MRI was really "necessitated" his insurance company probably would have paid for it. Certainly he or his physician could have appealed if they thought the denial was unreasonable. Maybe he didn't need the MRI at all, but the doctor wanted to boost his own income. Medical imaging is one of the most overused technologies and if anything we need more intervention from insurers and radiology benefits managers ... rather than less. Also, although Kellerman says insurance companies' "first step" is to harm members by reduced service, in imaging and diagnostic testing in general less can be more. An MRI probably won't hurt you but other popular modalities like CT very well may. (See Image gently, or when the diagnostic is worse than the disease .)

The sudden reduction of the fee from $3000 to $1000 and the doctor being "tickled to get it" doesn't ring true either. Is Kellerman claiming (as he seems to imply elsewhere in his article) that a doctor would rather get $1000 from a retail patient than $3000 from an insurer? I doubt it. I don't know about you but I'm not keen to go back to the days of "usual and customary" fees or enter the world of the bazaar every time I go to the physician's office or hospital. Maybe Kellerman could have gotten the scan for free as a professional courtesy, but what about the rest of us? I wouldn't be surprised to find that certain groups end up paying more for the same services -- and it won't necessarily be those with greater financial means.

Rather than this senseless vilification of the insurance industry, which leads to simplistic and incorrect conclusions, I'd like to see a discussion about how insurance companies can shift to meet the needs of consumers, beyond simply offering Consumer Directed Health Plans. As consumers assume more of the cost for their health insurance -- either because they pay their own premiums or have to pay a greater share of what's offered by their employer -- I expect consumers will increasingly turn to managed care for help in figuring out what services really are necessary and which providers offer high quality care at a reasonable cost. In addition I expect there to be an opportunity for insurance companies or third-parties to help audit and negotiate bills for health care services. They could start with a close look at hospital bills, which consumers are essentially hopeless to decipher.

Mr. Williams' Web site recently celebrated its third anniversary, and he set up a post detailing the greatest hits from the past year. His latest venture will be hosting Grand Rounds on May 13, 2008. Check it out as he links to the "greatest hits" of the entire medical blogging world for the previous week.


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