Wonder what health care issues most concern the medical profession?

In the following report, Dr. Shastri Swaminathan, president of the Illinois State Medical Society, talks to The News-Gazette about what's on doctors' legal and legislative agendas right now:

1. What do you see as the chief concern for doctors and their patients in Illinois?

Definitely, access to medical care. The constitutionality of the state's 2005 medical liability reform law (which placed caps on some kinds of economic damages that could be collected in malpractice lawsuits against doctors) is under review by the Illinois Supreme Court, and it's essential that those caps remain in place to keep liability costs for doctors affordable, Swaminathan said.

2. How do malpractice damage caps affect access to care?

Prior to 2005, 26 out of Illinois' 102 counties were without an obstetrician to deliver babies because the malpractice liability insurance rates on that specialty have been particularly high. Less than 30 percent (compared to 70 percent in many other states) of Illinois' medical school graduates remained in the state, and many counties were without specialists patients need – once again due to high malpractice rates, he said. It's simply been cheaper for doctors to practice in neighboring states.

But since damage caps have been in place, "we've seen doctors coming back to Illinois," Swaminathan said.

Plus, he adds, more new doctors are staying when they get out of medical school.

3. What are other factors affecting access to care?

– Illinois' public aid payment problems. In terms of how well states reimburse providers for the care of Medicaid patients, Illinois comes in 47th. Young doctors burdened with heavy medical school debts to pay especially can't afford to treat these patients.

– 1.5 million people in Illinois don't have health insurance. The physician organization rejects a single-payer universal health plan solution, but would like to see tax credits that would allow choice and reforms to make health insurance more affordable.

"Essentially what we're saying," Swaminathan said," "is redistribute the money and give citizens a choice."

4. Why aren't we doing that now?

Illinois just doesn't seem to have the political will to find a way to fund medical care for all people.

5. What about all these quick clinics springing up in retail stores?

Doctors believe each patient needs a "medical home," meaning a physician guiding their overall care on a regular basis. Retail clinics should be strictly regulated, function under the supervision of a doctor and should coordinate with patients' regular doctor when care is delivered there.

6. With a 10.6 percent cut in Medicare rates to doctors averted by Congress earlier this summer, is Medicare payment reform still an urgent concern?

Yes, because doctors were only guaranteed the current funding level for 18 months, and doctors could face even steeper cuts in 2010. Plus, the recent legislation didn't address the change in reimbursement structure doctors believe is essential. Doctors want a rate system that reflects their costs.

Swaminathan, a Chicago-based psychiatrist, is medical director of the Department of Psychiatry at Advocate Illinois Masonic Medical Center, Chicago, and a clinical associate professor at the University of Illinois College of Medicine.