Today's Health Care Ration-by-Hassle Moment: Lamorinda Pediatrics

In Lamorinda Pedriatics, 930 Dewing Ave., Lafayette, CA, 9:00 AM for the second dose of a vaccination:

"I'm sorry, sir, we can't give vaccinations now. We only give vaccinations from 9:30-11:00."

"But we're here now..."

"But we can't give vaccinations now. You will have to wait until 9:30."

"But why can't you give vaccinations until 9:30?"

"It is our policy."

"So you could give the vaccination now, but won't."

"It is our policy that we cannot give vaccinations until 9:30."

"Could we make an appointment to get the vaccination done at some more convenient time for us?"

"I'm sorry, sir, we can do vaccinations on an appointment basis. We can do vaccinations on a walk-in basis only, from 9:30-11:00."

"Do you realize that your policy inconviences two-earner families?"

"I'm sorry you feel that way sir."

"That limiting vaccination hours to 9:30-11:00 makes it a significant hassle for some two-earner families to get here then?"

"I'm sorry you feel that way sir."

For us, it isn't a significant hassle: professors can rearrange their schedules to make the window (if given advance warning that that is the window). For others, it is. And vaccination rates would be lower than they would otherwise have been.

A well-designed health care-financing system would dock providers whose patients failed to get all their vaccinations. If we had a well-designed health care-financing system, bureaucrats would be chasing us down the street with syringes full of vaccines, rather than rationing-by-hassle.

Comments

[otto]

"If we had a well-designed health care-financing system, bureaucrats would be chasing us down the street with syringes full of vaccines, rather than rationing-by-hassle."

On that criterion, there has never been, and probably will never be, a well-designed health care-financing system at any time in human history.

[Jacob Christensen]

Doctors or nurses with syringes, yes.

Bureaucrats with syringes - scary thought. Very scary indeed...

Btw. my old mother would simply have grabbed the syringe and done the work herself - but on the other hand she is a retired nurse.

[beckya57]

Vaccines, of course, are notoriously unprofitable for the health-care system, so the incentive to ration-by-hassle is significant (I note you were given no reason for the policy). As for chasing people with syringes, of course no system does this (don't your other commenters have a sense of humor?), but I'll wager the better designed systems, e.g. France, do provide incentives or requirements to make sure people are vaccinated.

[otto]

There's no sense of humour failure here. It's just that Brad is failing to recognise that rationing by hassle is pervasive in healthcare provision.

[Randolph Fritz]

My girlfriend, a sometime medical student in Mexico City, was shocked to discover that standard practice in the USA was to charge for vaccination.

It is still true that there is no financial incentive in the US "health" "care" "system" to keep people healthy. Bah!

The USA: better than Galactus. (Sigh. I miss Fafblog.)

[Leila A.]

Adam Gopnik wrote in the New Yorker some years back that along with universal childcare and healthcare, the French offer well-child visits TO THE CHILDCARE CENTER. Since they're all covered, the doctor/nurse goes to the center and gives them their vaccines on site.

Then the two-earner parents don't have to leave work at all! And the schools don't have to spend time tracking and processing immunization records. Etc. etc. And I'll bet it costs the providers less to line up a roomful of kids and vaccinate 'em in one go.

Just sayin'.

Staggeringly efficient.

[Leila A.]

But we couldn't have what the French have, because that would be SOSHULIZUM.

[jerry]

A well-designed health care-financing system would dock providers whose patients failed to get all their vaccinations.

Bleh. There are very good medical reasons that have nothing to do with crackpot ideas for people to avoid certain vaccinations that don't make sense in their circumstances.

Bad Incentive Brad! Bad Microeconomics Professing!

However, let me tie this into free/fair trade and H1B visas.

The insurance companies ration healthcare by hassle and you believe they should have office hours designed to fit the health care seeker's needs, not the insurance company's needs.

Similarly, Intel, Microsoft, et. al., complain that they cannot find trained employees, but most of them do not have any way for a job seeker to come in, in person, and speak to a hiring manager. Most of them allow resume submittals only online, and those resumes are then scanned by computer, making it very hard for a good candidate with a non-matching resume to be seen.

Clinics should encourage walk-ins.

H1-B Visa Employers MUST allow job seekers to apply in person and speak to hiring managers in person.

[Andrew Dennis]

The UK version is that GPs get paid according to vaccination targets met, and a modest paymnt per each vaccine administered. They send out polite form letters reminding me which shots I need updated on. I'm not sure all general practitioners are so organised, but since they get paid by the results it seems to make sense for them to get basic CRM software and use it.

[foo]

As economists we know that if customers demanded it, the market would provide. Also, we believe in zero transaction and information costs, as well as in zero time to realize opportunity. So... you must've imagined it.

[Barbara]

I love the idea of having doctors go to daycare centers. Wow!

But really, pediatricians in particular get used to holding the line because everybody wants everything done before 8:00 am or after 6:00 pm and no one can run an office that way. When pushed to the the breaking point once (sick child, wait three days for fever to see doctor EVEN THOUGH she was being treated with antibiotics that had obviously not done their job) my husband simply showed up with said very sick child at 8:30 am on a Monday morning -- and boy were they pissed -- but they agreed to see her.

In any event, every local health department will give vaccines for little or no cost, and at least in my county, they have evening hours in the summer.

[Anon]

In Canada, they run flu vaccination clinics at local malls during flu season. Shop, get shot up, shop some more... very convenient. You don't even need to be a Canadian or show a health card! Because preventing a flu epidemic is a lot cheaper than treating one.

Unfortunately, childhood vaccinations are still done at the doctor's office only.

On the H1B issues mentioned upthread: you have seen the immigration video going around, right? The one where a bunch of lawyers are running a conference teaching corporate HR reps how to disqualify all possible US candidates so they can apply for H1B visa candidates?

[jerry]

"On the H1B issues mentioned upthread: you have seen the immigration video going around, right? The one where a bunch of lawyers are running a conference teaching corporate HR reps how to disqualify all possible US candidates so they can apply for H1B visa candidates?"

Exactly. This is one reason of many why H1B employers must be forced to maintain onsite hr departments that can arrange on the spot interviews with onsite hiring managers. Companies that don't use H1B visas can do as they wish.

[ShortWoman]

I suppose you should consider yourself lucky the MA didn't just park you in a waiting room until 9:30 without ever explaining the delay.

As for "As economists we know that if customers demanded it, the market would provide," your situation merely demonstrates that you are not the customer.

[Aaron]

Paying based on getting everyone vaccinated misses people who refuse or delay vacc's -- I know plenty of people (non-autism-crackpots) who have gotten only a minimal set for the first year or so, and plan on getting more later, when the kid's immune system is a little more complete.

The flu vaccination plan is probably better done: a lot of employers do on-site shot days. It'd be great to do on-site shot days at school, but then again, who would pay for it? On-site shot days at work are done because everyone has the same insurance.

[Paul J. Reber]

I'm curious. Is there supposed to be a market-like mechanism could be constructed that would correct either the current "rationing by hassle" or apply pressure towards the ideal of incentivizing health care providers to chase you down and vaccinate you?

Docking providers who don't meet certain targets sounds like a state-controlled regulatory system that imposes a central bureaucracy on managing health-care providing.

I actually agree this is the direction to go to improve health care. But once you do this, I fail to see any possible use in also pressuring people to self-ration by hitting them in the wallet for seeking health care (as in the 20% proposal floated here a few weeks ago).

Flu vaccination is a great example. It's already inconvenient, painful, and has annoying side effects. My health care outcomes are supposed to be better if I *also* pay $10-$50 for it? If it's useful, it makes more sense to pay me to get the vaccine than the other way around. And "useful" here is a question of science more than economics.

[Sonia]

It probably reduces the cost of vacinations to have them done in blocks rather than scattered through the day. Having vacine clinic hours at various times of day several times a month is one way to meet the needs of families. Another way might be to get the vacination at WalMart or similar institution. WalMart is likely to have flexible hours. Providing health care at more convenient times and locations at lower prices means using more para professionals.

[Gene O'Grady]

Well, Barbara, on your sick child waiting three days to see a doctor -- when we lived in Rome our daughter woke up on Easter Sunday morning with another ear infection. We called the pediatrician who agreed to meet us at his office, examine her, and prescribe the needed (and effective medication).

The only difficult thing was getting across the city from Monteverde Vecchio to Parioli (if you've been in Italy that week you'll understand) to his office -- oh, and he charge about 25% extra.

It was to be in a country where they don't incentives too seriously.

[johntoff]

Medical care, including vaccinations, for pre-school children in Japan is provided completely free of charge. If I recall correctly, the health care system here monitors the vaccinations children have received and arranges appointments for vaccination shots with families.

It is also interesting to point out that visits to doctors here in Japan is relatively painless. Medical clinics are usually within walking distance (the nearest one is about a 4 minute walk from our apartment building) and the waiting time to see a doctor is usually no more than 15 to 20 minutes (without need to make an appointment I might add).

To be fair the Japanese health care system has major flaws. However, given that the vast majority of medical visits are for routine treatment, the dysfunctionality of the US medical care system for basic care is nothing short of astonishing. It is testimony to the American belief in the natural superiority of free markets even when confronted with evidence to the contrary and to the belief of American exceptionalism, that is, that there is nothing to be learned from the experiences of other societies.

[wcw]

The joke here, of course, is that if Lamorinda (in whose matchless arms, full dicslosure, I grew up) has niggling issues, how must the great unwashed live?

The data speak to it, but so does the neglect dealt the children of mere privilege.

[James Wimberley]

In France, mots vaccinations are caried out by GPs. See http://www.invs.sante.fr/publications/couverture_vaccinale/couverture_vaccinale.pdf, page 11. The results are in a table here: http://www.eurosurveillance.org/em/v08n06/0806-224.asp. France does better than the USA for everything except measles.

The difference seems to be that in a well-designed health care system you have special arrangements for monitoring vaccinations but no special arrangements for paying for them, it's just part of the normal system. So European providers don't have any externally-driven administrative incentive to set up special and therefore inconvenient schedules.

[JonF]

Re: In Canada, they run flu vaccination clinics at local malls during flu season.

They do things like that in the US too. I recall a few years back flu vaccine clinics scheduled at K-Mart in Michigan; and last year they did one at the office park where I work.