Comments on: Contracting With Patients To Follow Prescribed Treatment http://1heckofaguy.com/2006/08/28/contracting-with-patients-to-follow-prescribed-treatment/ A pastiche of posts, featuring song, dance, snappy chatter plus notes on prose, poesy, love, lust, life, and beyond Sun, 12 Oct 2008 17:19:07 +0000 http://wordpress.org/?v=2.6.2 By: Mrs. Linklater http://1heckofaguy.com/2006/08/28/contracting-with-patients-to-follow-prescribed-treatment/#comment-367 Mrs. Linklater Mon, 28 Aug 2006 11:20:04 +0000 http://1heckofaguy.com/2006/08/28/contracting-with-patients-to-follow-prescribed-treatment/#comment-367 What is it about coercion that bureaucrats don't understand? If you look at old black and white pictures of Chicago, for instance, a school and a church/temple anchored the neighborhood. Think an eight block square. In some areas there were churches on almost every corner. These anchors were joined by a police station and fire station. A large chain grocery took over the original mom and pop stores, which were another integral part of the landscape, along with a dry cleaning place, shoe repair, etc. Oh, yes, there were local doctors. And they made housecalls. The chains have fled the inner city, making healthy, fresh food difficult to access. Schools have closed. The doctors are holed up in the suburbs or hospitals. Probably the only good news is the attempt of law enforcement to establish a relationship with residents with beat cops who walk around getting to know people. Basically food, medical, educational, and human services have to return to the neighborhoods. Medical facilities in particular need to de-centralize. Perhaps a local medical care building could be located next to a police or fire station. Which would make sense in the city or out in the country. Hospitals need to have satellites in the neighborhoods so medicaid patients can see someone within WALKING distance. And I don't mean a Doc in a Box. Perhaps public health nursing could mean something again. There is a real opportunity for nurses to staff these places. They tend to be more empathetic anyway, n'est-ce pas? Retired docs could be enlisted to help out if they haven't all gone to Florida. At the very least, there needs to be a hospital bus service for the neighborhood that takes people to their appointments. Either for FREE or at a reduced cost. You try using public transportation with a sick kid. A regular bus with a schedule, plus a van for emergencies. It sounds like medicaid patients are being required to do all the heavy lifting. The more things change, they more they stay the same. What do medicaid recipients get in return for their agreement to be compliant and all those other requirements? NOTHING. What is it about coercion that bureaucrats don’t understand?

If you look at old black and white pictures of Chicago, for instance, a school and a church/temple anchored the neighborhood. Think an eight block square. In some areas there were churches on almost every corner. These anchors were joined by a police station and fire station. A large chain grocery took over the original mom and pop stores, which were another integral part of the landscape, along with a dry cleaning place, shoe repair, etc. Oh, yes, there were local doctors. And they made housecalls.

The chains have fled the inner city, making healthy, fresh food difficult to access. Schools have closed. The doctors are holed up in the suburbs or hospitals. Probably the only good news is the attempt of law enforcement to establish a relationship with residents with beat cops who walk around getting to know people.

Basically food, medical, educational, and human services have to return to the neighborhoods. Medical facilities in particular need to de-centralize. Perhaps a local medical care building could be located next to a police or fire station. Which would make sense in the city or out in the country.

Hospitals need to have satellites in the neighborhoods so medicaid patients can see someone within WALKING distance. And I don’t mean a Doc in a Box. Perhaps public health nursing could mean something again. There is a real opportunity for nurses to staff these places. They tend to be more empathetic anyway, n’est-ce pas? Retired docs could be enlisted to help out if they haven’t all gone to Florida.

At the very least, there needs to be a hospital bus service for the neighborhood that takes people to their appointments. Either for FREE or at a reduced cost. You try using public transportation with a sick kid. A regular bus with a schedule, plus a van for emergencies.

It sounds like medicaid patients are being required to do all the heavy lifting. The more things change, they more they stay the same.

What do medicaid recipients get in return for their agreement to be compliant and all those other requirements? NOTHING.

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