Medical Costs

In response to a letter from Sara B. Drescher (Nov. 5), let me assure Ms. Drescher that physicians and hospitals are not “exempt from criticism.” Newspapers seem to print more letters critical of health care providers than in praise of them.

Drescher’s main concern, however, was with a near $14,000 total bill for a cataract operation. I sympathize with her because that sounds like a lot of money for an outpatient procedure.

To set the record straight, I would like to present some facts about medical payments to physicians, specifically to primary care physicians, and more specifically to one pediatrician in solo practice in central Orange County. My patients are mostly divided between those with HMO and PPO insurance. I have a small number of patients with Medi-Cal, and even fewer with indemnity insurance.

The PPOs, insurance plans that let you pick a doctor from a list of “preferred providers,” typically pay 80% or less of what my fees were five years ago. This 80% includes the portion my patients are expected to pay as co-payments or deductibles. I am paid for my HMO patients by the month, not by the visit. This fee includes all office visits, hospital admissions, office surgery and office lab work such as throat cultures, urinalyses and simple blood tests. The monthly “capitation” payments are less than $20 for children under age 4, and less than $9 for children over 4. Fortunately, I am reimbursed for immunizations at my cost. Medi-Cal pays just about $11 for a typical office visit and $16 for a longer visit.

I would like the public to know that even among physicians there are differences in practice style and income. We pay the same rates you do for rent, telephone service, utilities, supplies, labor and insurance. Most of us in private practice are earning less and working just as hard as we did five years ago. I am thankful, however, that I can still earn a living working at a profession I love.

MARTIN J. ROSENFELD MD

Santa Ana