One study found that a group of Medicare patients admitted to high-spending hospitals were 2 to 6 percent more likely to die than a group admitted to more conservative hospitals.Why is this happening, then?
Above all, it’s the natural outgrowth of our fee-for-service health care system. It turns doctors into pieceworkers, as Ms. Brownlee puts it, “paid for how much they do, not how well they care for their patients.” Doctors and hospitals typically depend on the volume of work for their income, and they are the gatekeepers who decide when work needs to be done. They also worry about being sued if they do too little. So they err on the side of overtreatment.
So what then is the answer? Milton Friedman (rest in peace) once studied healthcare and found the one phenomenon accounting for half the increase in healthcare in the past 40 years has been the advent of third party payers; or in economic terms, someone interfering between the demander and the supplier (Medicare, Medicaid, insurance companies, etc.). Might it be prudent to have doctors negotiating the price with the actual demanders of their services?
ReplyDeleteThink of the last car you bought. I'll bet most of us could quote the year, most of the amenities (CD/mp3 player, leather buckets, five speed automatic, six cylinder 2.8 litre, ew, edl, etc.), what we expected to pay, what the sticker price was and to what we negotiated that price down. Can any of us tell even half that detail about our last physical? Especially the price. Do we still even know what was the actual price?
Luke, it's an interesting point you make and I agree with you, for the most part. I'm just wondering what you suggest as remedy.
Ever your student.
MJB