The MediCal system, which provides health care for the uninsured, is about to implode. I have been a medical provider for 30 plus years in California, and have seen the meltdown of the system first hand.

Of course, money is a big problem, but it is only one issue in a long list of difficulties: lack of reimbursement for services; non-timely payments to medical providers that extend over 2 years; administrative bureaucratic hassles; paperwork nightmares; medical management by non-medical people; and medical management by medical professionals who have never examined the patient. It is no wonder that so many medical and allied health professionals are stampeding out of the system.

Here’s just one example of the bureaucratic hassles. I moved to a different medical suite in the same complex and had to change my MediCal paperwork. That required filling out a form consisting of 32 pages and, even though I’m already in the system, I was denied four times over the course of a year-and-a-half because it was claimed that I didn’t fill in answers to the bureaucracy’s satisfaction. But my information was already in the system, except for the new address.

However, putting aside those bureaucratic aggravations, one of the major problems is that many of those who are covered by MediCal, unless they receive emergency care,
don’t think there is value to the service they get.

How do I know?

The no-show rates for medical appointments are incredibly high for many MediCal providers. At my clinic, after tracking patients for 18 months, we determined that 43% of daily scheduled patients didn’t show up and didn’t bother to call. No business can survive when almost half the daily scheduled patients don’t show up. Ever been in a MediCal clinic waiting room that is packed with people standing because there is no place to sit? That is because double and triple booking is common to assure a regular sized clinic. And on the occasion when everyone shows up, crowded waiting rooms are the result.

But in many clinics, the empty waiting room is more the norm. We have to find a way to establish a sense of worth for the services provided for those who accept MediCal. My suggestion is to charge an amount of money—even $1 will do — for every prescription and for every medical visit. Believe me, those of us in health care will NEVER turn away someone who doesn’t have the money. But if MediCal enrollees have to invest in their own care, it will have meaning for them. They will show up for appointments, take the medicines prescribed, and fill the prescriptions.

To stop MediCal providers from leaving the system we must pay fair compensation in a timely manner, and just as importantly, we must establish a sense of worth in the service being provided to the MediCal population.