At the Doctor's Office -- Take 2

When the president and Congress are talking trillions of dollars for universal insurance coverage and comparative-effectiveness research -- all the big-dollar items of healthcare reform -- they tend to ignore the small practical steps that really could add up to make a huge dent in our national healthcare dollar.

Take the doctor's office, for instance. If doctors and other healthcare providers followed the lead of veterinarians in offering evening and weekend hours and took other steps to prevent lengthy office waits, we could see some real savings. For example, let's say Sally, an expectant mother, makes $15/hour (the median average wage for women in 2004, according to the U.S. Census Bureau). Over the course of her pregnancy, she will make at least 10 prenatal visits to the doctor. While her HMO will cover most of the cost, she will have to miss an average of three hours of work for each doctor's visit (including the commute), so she will miss a total of 30 hours of work because the doctor's office won't work around her schedule. If she doesn't get sick leave, she will lose $450 in pay. And even if she is covered, her office will lose 30 hours' worth of productivity.

According to the Centers for Disease Control and Prevention, 4,265,555 babies were born in the U.S. last year. For the sake of our example, let's just say that 3 million of the women giving birth to those babies worked and made an average of $15/hr. That would mean that in one year, the nation would lose $1.350 billion in productivity for this prenatal care. Over 10 years, that would total $13.5 billion. If you add to this the cost of time off work for all employees to go to the doctor or take their families to the doctor, the amount would be staggering.

Now, no one is suggesting that people shouldn't go to the doctor. But when people can't afford to take off from work for routine doctor visits, they end up going to the emergency room or waiting until their condition gets critical, both of which addseven more to the national healthcare bill. All of these problems could be addressed if we simply change the hours doctors, physical therapists, etc., practice -- or at least cut the amount of time people waste while waiting in the doctor's office.

But since this is a solution that could save billions of dollars while costing us nothing, it probably won't find its way into any national agenda for healthcare reform any time soon.