Fixing health care – focus on payment

DB,

Health Affairs Blog has had a nice series, pretty wonkish, regarding the payment system as set by Medicare. They address the problems, offer some suggestions for change, and talk about what may be coming down the pipeline. The whole series is worth a read, but I found this entry particularly interesting, RE: the CHAMP act.

http://healthaffairs.org/blog/2008/02/21/the-%e2%80%9cdoc-fix%e2%80%9d-the-champ-act-approach-to-medicare-physician-payment-reform/

Gives some sense of where we might be heading.

Actually, paying more does not always generate a superior outcome. Take the schools in the District of Columbia, or many other city systems. Taxpayers pay plenty for those schools, which have very high per pupil costs, and they deliver little.

I agree that health payment systems are crazy, but I am not sure that MORE money is the answer. I think focusing on bang per buck might be as successful.

I’d say that agrees with your notion that thinking should be paid for at the same or superior rates to doing. But I do not think that the focus on payments alone will get us what we want or need.

Actually, we really aren’t talking about private enterprise when it comes to physician payments–that’s the point. Because of the way the government pays doctors for Medicare and Medicaid patients, you make the same amount whether you do a good or poor job. In fact, I would say you make more if you “churn” patients–handle just 1-2 problems per visit and make them come to see you more frequently, then if you do what patients would like, which is to handle a number of problems at a single visit. I think the former is inferior care, but MDs who do that well make more money. Moreover, if we go to some type of single-payer system, or expand Medicare to cover the entire population, like some people seem to want, this situation will worsen. Already doctors often don’t do what patients want, because it isn’t in their financial interest to do so. Patients want doctors to spend time, explain things, order the tests and prescribe medications according to the patient’s preferences, and they would like phonecalls returned and their care coordinated with specialists, etc. It is NOT in a physician’s financial interest to do most of this, because it is not paid for, in fact the doctor has an incentive NOT to do these things because he needs to do the things that pay. It’s a sorry state of affairs and I don’t think it will get better until patients and doctors revolt.