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Gatekeepers, usually general practitoners or internists, are not efficient when they become middlemen, referring the patient to another physician. Referrals increase costs directly, by requiring another visit to a doctor, and indirectly, by delaying diagnosis of conditions that become more expensive to treat the longer they go untreated. Nor are gatekeepers necessarily efficient when they themselves treat patients. The fans of gatekeeping assume that a generalist’s fees will be lower than a specialist’s, but that’s not always true. Cardiologists and neurosurgeons often charge more for an office visit than generalists do; pediatricians, dermatologists, and orthopedic surgeons often charge less. Fees for office visits aren’t the only costs of treatment. Consider a 1983 Emory University study that compared how dermatologists and family practitioners would manage treatment of ten different skin diseases. Compared with the generalists, the specialists ordered tests that cost only half as much, and they would have required patients to return less often for treatment. While the specialists wrote more prescriptions, the total cost of medication wasn’t much higher. Taking everything into account, the dermatologists would have provided care for 10% less cost than the family practitioners. — Myth 2: Gatekeeping ensures effective diagnosis and treatment. In the Emory University study, much of the additional expense incurred by family practitioners was due to misdiagnosis.
We apologize for the inconvenience. Please try again later. KUALA LUMPUR: Three university teaching hospitals under the Education Ministry have produced more than 7,000 experts in various medical fields in the country, said Datuk Seri Najib Tun Razak. The teaching hospitals are University of Malaya Medical Centre (UMMC) in Kuala Lumpur, Hospital Universiti Sains Malaysia (USM) in Kubang Kerian, Kelantan and Pusat Perubatan Universiti Kebangsaan Malaysia (UKM) in Cheras. The Prime Minister said the medical experts contributed and served in Internal Medicine, Surgery, Obstetrics and Gynaecology, Orthopaedics, Otorinolaringology, Ophthalmology and Paediatrics. “In the field of pediatrics or children, the three university teaching hospitals have produced more than 450 experts,” he said in his speech when launching the Permata Children Specialist Hospital at the UKM Medical Centre, here today. Also present was his wife, Datin Seri Rosmah Mansor, who is also the patron of PERMATA Negara. Najib said the first Permata children specialist hospital in the country was expected to be ready in 2017 and would become another teaching hospital to train more doctors and child specialists as well as sub-specialists in the various paediatric disciplines. The hospital will have 135 experts and medical officers as well as more than 1,700 support staff. In addition, the Prime Minister said 12,000 medical doctors had been produced by the 17 other public and private institutions of higher learning offering medical doctor degree programmes. Najib also said that the doctor: population ratio in the country had reached 1 doctor for every 800 residents and this was expected to reach a ratio of 1:600 in 2015, that is the standard stipulated by the World Health Organisation. “The government has implemented a very comprehensive health service system, including rural maternity services, rural clinics, health clinics, district hospitals, general hospital and tertiary hospital like the Hospital Kuala Lumpur,” he added. Story first published on: August 24, 2013 07:48 (MYT) Tags: Datuk Seri Najib Tun Razak, Education Ministry, medical Also See