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pay doctors according to how healthy their patents are

Page history last edited by PBworks 17 years, 3 months ago

We could pay doctors according to how healthy their patents are.

Reasons to agree

  1. Doctors make more money the sicker their patients get.
  2. If people really had choice you could let the free market fix it, but they don't. If we go to a managed system (saying that our system is not already managed) we should not forget the lessons learned in the free market. "Economic reward" (or if your a socialist "greed") can be used to reward people for doing their job well.
  3. Lack of motivation for Doctors to actually improve the health of their patients.
  4. There should be rewards for good behavior and punishments for bad behavior.
  5. People who do a better job should get promoted.
  6. I know doctors are generally well intentioned, but the system is not set up to reward the best Doctors.
  7. I guess with lawsuits it is sort of set up to punish bad doctors, but we need the carrot of a reward, not just the threat of a stick.
  8. If doctors were assigned a certain number of patients, in a certain age group, they would be paid according to an algorithm that would endeavor to pay the most to the doctors that had the healthiest patients. The algorithm may need to be complex taking account of patient circumstances. Statisticians would have to be involved, and because doctors may only see about 15 people a day, it may take a couple of years of statistics to see the good doctors from the bad doctors.
  9. We could require all patients to do feedback, and allocate pay bonuses based on the patient feedback.
  10. Pay doctors according to the health gain of their patents, as apposed to just the overall health. This would eliminate the desire to only take healthy patients (if doctors were assigned patients at random this wouldn’t be an issue).
  11. “Consider capitated practice plans. The doctor is paid X amount to care for y patients. Sickness is expensive, and will use up the allocated X more quickly. The doctor must keep patients well, because that is cheaper. Since the doctor has already been paid, there is no incentive to take on more patients to increase his pay, do more expensive procedures / tests to increase pay, etc. In such practices, patients might be asked to come into the clinic every day for a blood pressure check, until it was controlled. Pointless lab tests are kept to a minimum, while those with potentially high payoff (in terms of keeping down expenses) are used frequently.”
  12. It would be interesting, potentially, to have available wellness statistics for doctors, just as we do for certain treatments.
  13. This is a no-brainer. There should always be a carrot and a stick approach towards everything that leads to better societies.
  14. In business you make more money the better you do. In health you make more money the sicker your patients are.
  15. When I go to the Doctors office I never see them mention how much test cost. They get paid for the number of hoops I have to jump through.
  16. We don't really have choice in our system. Their is no Wal-Mart to go to for health care. Everything is a Lexus. True, not all doctors graduated at the top of their class, and maybe some doctors are more expensive than others, but I never feel like I really am in control of how much I spend. It's way too complex. A lot of people are going to India or South America, because Doctors cost so much in this country. They cost so much, because Medical School is so expensive. I think we should identify the things that it doesn't take an intense knowledge of molecular biology to know. Mid-wife's are a good idea. However, I don't think mid-wife at home are a good idea. A doctor needs to be there if things are un-usual. But do you need to have a thorough knowledge of molecular biology to give someone a suture? If you wanted a real doctor, maybe you could pay more, but I think Wal-Mart should get into the health care industry. Most medical procedures are no more complex than fixing a car, and can be trained without all of the back ground information. You only need all the background information if you are going into medical research. They should have a degree that takes less time, that just tells people how to make people healthy. They would have fewer medical school bills, and could charge less. Just for those of us who have less.


Reasons to disagree

  1. Only a minority of a person's health depends on health care.
  2. “Anecodotal evidence to the doctor's effectiveness already drives patients, so at least in theory what the doctor makes does depend, if indirectly, on what the doctor does. So on balance, I don't think that the idea has much new to offer.”
  3. “I should expect that Harold Shipman had a fairly high healthiness rating for his patients, perhaps aided by his statistically anomalous death rate.”
  4. “Further, there are whole segments of the profession (from allergists to plastic surgeons to chiropractors) that absolutely, positively depend on the near substance dependence type (re)visiting patterns of their patients” (whatever this means. Am I slow, or do these words not make any sense? I would post reasons to disagree but I don’t really understand what he is saying.)


Origin of Idea


I had this idea when listening to an NPR story about how Doctors have no incentive to spend time with their over-weight patients in counseling them on how to live healthy lives. Doctors only seem to be paid when they give a prescription, or put on plastic gloves. Instead we should incentive-ize (pay) doctors to help their patents live healthy lives.


Other ways of implementing this principle

  1. Teachers who teach more, should also get paid more.
  2. Prisons that reform their inmates better, should be paid better. Statistics could be used, about which facility has the lowest repeat violent criminals, etc. Prisons could be viewed as educational facilities about how to control your temper. I image violent movies/music being banned. Opera, Dr. Phil, and a 24 hour soup for your soul channel being broadcast. If their was money in it, people would be competing who could come up with the best formula. Does Johny Cash music help sooth violent tendencies? Would motivational speakers help? All questions for the free market to fix.


Books that might agree

  1. Freakonomics (talks about incentives)

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