Indirect costs

Even as American attitudes towards doctors began to shift in the nineteenth century, there was one factor which placed severe limits on a doctor’s ability to establish a practice: the cost of providing his service. Primarily this was because the doctor had to travel from patient to patient in order to do his work, and travel was difficult and expensive even over short distances; a common fee schedule was 50 cents for the visit, plus one dollar for each mile the doctor had to travel. It was also expensive to let the doctor know that he was needed, usually requiring a trip to find him on the part of a family member or neighbor. Rural people were reluctant to go to town to see the doctor, knowing that they would probably lose a day’s work on the farm and not knowing if they would find the doctor once they got there, since he might very well be out on call. As a result, the indirect costs incurred when seeing a doctor far outweighed the direct cost of his service, and folks were either unable or unwilling to pay those costs.

Hard roads were the first innovation that made a doctor’s travel quicker and more efficient. Railroads also helped doctors who focused on consultation; they were able to cover wide areas, and even to barter medical care to railroad workers in exchange for their fare. And when the car came along doctors were able to increase their home visits four- and fivefold.

Meanwhile, the telephone made it possible to establish an appointment system. Initially almost all office visits were done on a drop-in basis, with no guarantee that patients would find the doctor there or that a doctor would have patients on a given day. But as patients were able to call ahead they became amenable to scheduling a time for their visit.

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2 thoughts on “Indirect costs

  1. “Rural people were reluctant to go to town to see the doctor, knowing that they would probably lose a day’s work on the farm and not knowing if they would find the doctor once they got there”

    Times really haven’t changed all that much, have they! In the 21st century we spend more than a day’s wages for an office call and when we do see the doctor the visit is scheduled for no more than 15 minutes because they have three other patients to see that hour. We leave with few if any real answers and more questions than we came in with. The treatments usually deal only with symptoms and not the real disease. And in the end, it is still true today that the costs incurred usually far outweigh the benefits.

  2. Medical care/ availability is far and away better than at any time in history; however, the Law of Unintended Consequences has affected us adversely, as well for that very same reason. It seems that folks will go to the doctor for anything and everything nowadays. That accounts not only for the time lost from work but the overcrowded, cattle chute process in the doctor’s office.

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