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pay doctors according to how healthy their patents are

Page history last edited by Mike 1 month, 3 weeks ago

Help me automate conflict resolution and cost-benefit analysis for this statement: 

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

Reasons to agree.

  1. Doctors currently have little financial incentive to improve their patients' health, as they make more money when patients are sick.
  2. Rewards for good behavior and punishments for bad behavior can be effective in shaping outcomes.
  3. Doctors who do a better job should be rewarded and promoted.
  4. An algorithm could be developed to pay doctors based on the health gain of their patients, taking into account various factors.
  5. Patient feedback could be used to allocate pay bonuses to doctors.
  6. Capitated practice plans, where doctors are paid a fixed amount to care for a set number of patients, could incentivize keeping patients healthy.
  7. Wellness statistics for doctors could be made available, similar to treatment outcomes.
  8. A carrot and stick approach can lead to better societal outcomes.
  9. In business, financial rewards are tied to performance, and the same principle could be applied to healthcare.
  10. Patients often lack control over healthcare costs, and a performance-based pay system could help address this issue.


Reasons to disagree.

  1. Only a minority of a person's health depends on healthcare, with other factors like lifestyle and genetics playing a significant role.
  2. Anecdotal evidence of a doctor's effectiveness already drives patient choice, indirectly linking a doctor's income to their performance.
  3. A performance-based pay system could potentially be gamed, as in the case of Harold Shipman, a doctor with a high healthiness rating but also a statistically anomalous death rate.
  4. Some medical specialties, such as allergists, plastic surgeons, and chiropractors, depend on patients regularly visiting for ongoing care.


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 incentivize (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)


2. Identify Interests

Interests of those who agree:

  1. Aligning financial incentives with patient health outcomes
  2. Rewarding doctors who provide high-quality care and promote wellness.
  3. Empowering patients and increasing transparency in healthcare costs

Interests of those who disagree:

  1. Acknowledging the complex factors that influence health beyond healthcare.
  2. Maintaining the current system of patient choice and market-driven incentives
  3. Protecting medical specialties that rely on ongoing patient care.

Shared interests:

  1. Improving patient health outcomes
  2. Ensuring access to quality healthcare
  3. Managing healthcare costs effectively


3. Objective Criteria for Assessing the Validity of the Belief

  1. Evidence of the impact of financial incentives on healthcare provider behavior and patient outcomes
  2. Data on the relative influence of healthcare versus other factors on individual health
  3. Case studies of performance-based pay systems in healthcare and their effects on quality, cost, and patient satisfaction


4. Analyze Underlying Issues and Root Causes

  1. Misalignment of financial incentives in the current healthcare system
  2. Limited patient control over healthcare costs and provider choice
  3. Challenges in measuring and attributing health outcomes to specific healthcare interventions


5. Identify Unstated Assumptions

  1. Assuming that financial incentives are the primary driver of doctor behavior
  2. Assuming that patient health outcomes can be accurately measured and attributed to individual doctors
  3. Assuming that a performance-based pay system would be feasible to implement and maintain


6. Propose Top-rated Solutions

  1. Develop a pilot program to test performance-based pay for doctors in a limited setting, with careful monitoring and evaluation of outcomes
  2. Invest in research to better understand the relative impact of healthcare versus other factors on individual health
  3. Explore alternative payment models, such as capitated practice plans, that align incentives with patient health while allowing for ongoing care when needed


7. Conduct Cost-Benefit Analysis

Potential Costs of Agreeing:

  • Financial: Increased healthcare costs if doctors focus on short-term health gains over long-term wellness (Moderate likelihood, High impact)
  • Quality: Potential for gaming the system or neglecting patients with complex health needs (Low likelihood, High impact)

Potential Benefits of Agreeing:

  • Health: Improved patient health outcomes and increased focus on preventive care (Moderate likelihood, High impact)
  • Financial: Better alignment of healthcare spending with value and outcomes (Moderate likelihood, Moderate impact)

Potential Costs of Disagreeing:

  • Health: Continued misalignment of incentives, leading to suboptimal patient health outcomes (High likelihood, Moderate impact)
  • Financial: Ongoing challenges with healthcare cost control and transparency (High likelihood, Moderate impact)

Potential Benefits of Disagreeing:

  • Stability: Maintaining the current system, which allows for patient choice and specialty care (High likelihood, Low impact)
  • Feasibility: Avoiding the challenges and uncertainties of implementing a new payment system (High likelihood, Low impact)


8. Identify Key Resources

Best Supporting Evidence (Agreeing):

  • Studies showing the impact of financial incentives on provider behavior and patient outcomes
  • Examples of successful performance-based pay systems in other industries or healthcare settings

Best Weakening Evidence (Disagreeing):

  • Research highlighting the complex factors beyond healthcare that influence individual health
  • Case studies of unintended consequences or challenges with performance-based pay in healthcare

Most Credible Supporters (Agreeing):

  • Health policy experts and economists who advocate for value-based healthcare payment models
  • Patient advocacy groups focused on improving healthcare quality and affordability

Most Credible Opposers (Disagreeing):

  • Medical professional organizations concerned about the feasibility and potential unintended consequences of performance-based pay
  • Researchers who study the social determinants of health and the limitations of healthcare interventions


9. Analyze Values and Ethics

Values and Ethics of those who agree:

  • Prioritizing patient health outcomes and wellness
  • Valuing accountability and alignment of incentives in healthcare
  • Emphasizing the importance of prevention and early intervention

Values and Ethics of those who disagree:

  • Respecting the complexity of factors that influence individual health
  • Valuing patient choice and the role of ongoing care in managing certain conditions
  • Prioritizing the autonomy and professional judgment of doctors


10. Review Supporting Media

Supporting the Statement:

  • Documentaries or news stories highlighting the misaligned incentives in the current healthcare system
  • Infographics or data visualizations showing the potential impact of performance-based pay on health outcomes and costs

Opposing the Statement:

  • Opinion pieces or interviews with medical professionals discussing the challenges and potential unintended consequences of performance-based pay
  • Research reports or presentations emphasizing the importance of social determinants of health and the limitations of healthcare interventions


11. Explore Alternative Framings

  • "A carefully designed and monitored pilot program for performance-based pay could provide valuable insights into aligning incentives with patient health outcomes while addressing potential challenges and unintended consequences."
    • Equivalency score: Moderate
    • Topic equivalency score: High
    • % positivity: Moderate
    • % strength: Moderate
    • % specificity: High
  • "Improving patient health outcomes requires a multi-faceted approach that addresses both healthcare quality and the broader social determinants of health, with performance-based pay being one potential tool among many."
    • Equivalency score: Low
    • Topic equivalency score: Moderate
    • % positivity: Moderate
    • % strength: Moderate
    • % specificity: Moderate



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