Blogs & Comment

Inner workings of walk-in clinics

I was in a walk-in clinic today for a check-up (by appointment) and got a look into the inner workings of our public health system. It reminded me of a recent post by blogger Michael James on Moneyon how our public health care system is not so free after all.
At the end of my visit, the doctor informed me that he may be leaving the clinic. The owners were pressuring him to get his time down to 10-12 minutes per patient, he explained.Hes only a few years out of med school and still believes in spending time with his patients.
He was also being asked to takemore walk-ins (to get his patient-times down) and to perform cosmetic services such as Botox injections (prevents formation of wrinkles by paralyzing facial muscles). He definitely did not want to be injecting Botox into people regardless of the demand.
Maybe its because I just started going to walk-in clinics (my previous, doctor of 20+ years moved to another city last year), but I was also rather surprised by the long list of extra fees postedon the waiting-room wall. Hospitals have their exorbitant parking fees as Michael James noted, but this clinic had nearly 3 dozen user fees,” most of which would set you back more than hospital parking. Some of them were:

  • Missed appointment (no re-booking until fee paid) $60
  • Missed Physical (no rebooking until fee paid) $120
  • Sick note $20
  • Prescription renewal by fax/phone $15
  • Drivers Medical Examination form $50
  • Citizenship and Immigration Report $110
  • CPP Disability Medical Report $105 Travel Cancellation Form $30
  • Wart removal $20
  • Transfer of medical records $35
  • Faxing and copying $25

I understand how user fees can cut down on wasteful and careless use of resources, and how a certain level of imperfection will exist in any system. But the situation perhaps bears watching.
Some of those extra fees are beginning to look rather high to me already. The profit motive usually results in a more efficient allocation of resources but carried too far, it could have socially undesirable aspects such as restricted access to health services.
There was also a notice on the waiting-room wall entitled Office Policy. Some of the policies seemed to be aimed at generating more visits, prescription renewals over the phone. The same for test results.
Coming in to see a doctor to get a prescription renewed or be told your blood test was A-OK seems not only a waste ofsystem resources but also a waste of time for patients.
The pressure to spend more time in cosmetic activities such as Botox injections is also a concern. Could pressuring doctors to do more of these revenue-generating procedures begin to infringe too much on regular medical examinations and diagnostics?