Interesting discussion. And, I probably know less about the overall macroeconomics of healthcare than anyone. Any while pharmaceutical companies and insurance companies are a huge part of the problem, there are many, many small things that add up. Except for poor reimbursement and prior authorizations for prescriptions, MaineCare does little to curb costs. You could order two MRIs and a CT scan in one week, and MaineCare will cover it.
A classic example of a misuse of the system, which happens all the time is a patient with Medicaid (I am not trying to single them out -- it just doesn't work the way I am describing with private insurance)calls out office at 12:30 pm because her daughter has hives. We give her a 3:15 pm, but she can't wait that long. So, she goes to the Walk-In Care where they diagnose her with hives, prescribe Benadryl (which is covered) and do a Pertussis swab. She then drives over to the office at 3:15 pm thinking it may still be open so she can be seen so "I can explain the cause of the hives better." Now, when she went to the WIC during office hours, WIC calls for a referral. We, of course, refused to give it, but WIC has to see her anyway. Even though WIC will tell them they will get billed, it is illegal to charge MaineCare for anything. MaineCare will possibly send a letter teaching them, "how to use the healthcare system better."
I know this is a outdated term, but we really need to get some tough love in these situations. WIC, simply, should refuse to see them, or if WIC deems the visit not urgent, the patient should be required to pay.
