the important and the not-so-important, horribly conflated.

all together now…

In healthcare on June 19, 2009 at 2:03 pm

the times‘s excellent “room for debate” blog has a great roundtable on health care reform, highlighting the importance of adjusting doctors financial incentives to lower costs in an industry that receives one out of every 5 dollars americans make. i distill some of the arguments/suggestions/rants below:

Dr. Fisher (Dartmouth): “An underlying cause of this overuse [of certain diagnostic or surgical procedures] is a fragmented and uncoordinated health care system where each physician only focuses on a tiny piece of the patient’s care. Most physicians, even those in primary care, have become “partialists.” And the payment system that rewards overuse by physicians and encourages hospitals to compete in a local medical arms race to offer every possible profitable service.”

Dr. Pho (N.H): “Physician payments need to be divorced from the volume of care and instead associated with evidence-based quality measures and a reduction in medical errors. [D]octors should be “incentivized” to take the time to counsel and guide, along with improving their communication with patients, not only in person, but over the phone and on the Internet.”

there’s more below…

Physicians for a National Health Program: “The individual mandate now popular in Congress would merely force the uninsured to buy defective policies – boosting revenues for insurers but not protecting patients.” They add that even quality-of-care incentives can become distorted, but offer a weak and hardly hippocratically kosher example of this. In sum: single-payer, national system the only way to go.

Prez of the AMA: “Medical liability reform is also needed, and President Obama has recognized that defensive medicine contributes to unnecessary health care costs. Until physicians no longer fear lawsuits if they don’t order every test to rule out every possible option, defensive medicine will continue.”

Dr. Callender (Howard): Let’s move towards team medicine: “[T]he team approach can [yield] savings by preventing overtesting and other unnecessary services. Doctors who aren’t talking to each other might end up duplicating efforts. I find that a team or holistic approach not only allows for better monitoring of the patient, it also provides increased opportunities for consultation among medical professionals and better decision-making.”

Dr. Yore (Seattle): why are heart surgeons paid not 2 or 3 but 5 times the amount of the doctor who diagnosed the patient’s condition in the first place? “over-utilization is a driver of cost, and it is in part driven by doctors’ economic incentives. The underlying cause, however, is a bias within the physician compensation system that extravagantly rewards surgical procedures performed compared to “cognitive” services like diagnosis and medical management.”


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