In the first NYTimes article on modern medicine (early this week, but I'm too lazy and too far behind to check), they said the outcome for patients with no personal physician going into an illness was far worse than for patients with a physician. And talked about the problems of the patient in dealing with multiple specialists who might offer multiple recommendations for treating an illness.
Based on my recent experience, the article is true enough. I'd focus on the data problem: each specialist needs his or her own data. Actually, "specialist" is misleading--it raises the specter (ouch!) of a white coated expert "...ist". What I, as a layman with no recent experience of modern medicine, didn't realize was that each test involves a different organization. For example, the patient is referred by the personal physician to a medical lab for X-rays and blood work preparatory to a hip replacement operation. But in this case, the "lab" is a building, housing multiple testing organizations, X-ray being one and blood work being another. So the patient ends up going from one to the other, filling out forms for each with partially redundant information. Because the lab is separate from the personal physician, there's potential delay and loss of data. In fact, in the case of my sister, the blood work didn't get back to the physician for several days. This failure to communicate delayed diagnosis and treatment of an infection, which means a considerable cost in money, use of scarce hospital beds and staff, and suffering.
Comparing this experience under private health insurance to my own limited experience with HMO's, it's likely the communication among units would be better and the costs reduced. Costs for the patient and the system. But what's a cost for the payer is income for the payee. And the physician and labs have more freedom under the current system. It's all tradeoffs. (More to follow).
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