A Quote by Mitch Kapor
Physicians today, as human beings, are not exempt from the perverse economic pressures created by fee-for-service regimes to see more patients for shorter appointments and order more tests and procedures. If the incentives were changed to pay to foster better health outcomes, I am convinced physician behavior would change over time.
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Pay-for-procedure or fee-for-service reimbursement rewards doctors and hospitals for volume - not keeping patients healthy or being efficiency. Pay-for-Performance is clearly one tool that can change the incentives to reward quality.
What the Affordable Care Act started was a change in the American health care system from paying for procedures to paying for outcomes, paying for health. Other nations have already made that move. We pay for procedures and we get the best procedures in the world and we get the most procedures in the world, and then we spend a huge chunk of our GDP on health care, but we don't have the best outcomes.
We have a fee-for-service system that rewards quantity, not quality: profit-driven care rather than patient-driven care. So doctors order more tests, more procedures, and more drugs - we actually consume more prescription drugs in the U.S. than the rest of the world combined.
I resisted using EHRs while an internist in Boston, as I wrote in my blog, ‘Why Be a Meaningful User.’ Over time, however, I found that working with health IT made me a better and safer physician. Most importantly, my patients received better, safer care and improved outcomes.
My opinion is, that more harm than good is done by physicians; and I am convinced, that, had I left my patients to nature, instead of prescribing drugs, more would have been saved.
I think that if you have a single payer system and an opt-out for people who want to pay more [for better service, etc.], I think it would be better - and I think we'll eventually get there. It wouldn't be better at the top - [our current system] is the best in the world at the top. But the waste in the present system is awesome and we do get some very perverse incentives.
One of the jewels in the crown of Labour's time in office was the rescue of the National Health Service. As the Commonwealth Fund, the London School of Economics and the Nuffield Foundation have all shown, health reforms as well as additional investment were essential to improved outcomes, especially for poorer patients.
Lets take away the incentives to do 'to' patients and instead create incentives to do 'for' patients, to be 'with' patients. We don't need to do comparative effectiveness trials to see if that works; we can just ask patients.
Meaningful health reform needs to provide incentives for physicians and other health professionals to teach their patients healthy ways of living rather than reimbursing primarily drugs and surgical interventions.
I am not interested in things getting better; what I want is more: more human beings, more dreams, more history, more consciousness, more suffering, more joy, more disease, more agony, more rapture, more evolution, more life.
If our sex life were determined by our first youthful experiments, most of the world would be doomed to celibacy. In no area of human experience are human beings more convinced that something better can be had only if they persevere.
Doctors and hospitals should be paid for keeping their patients well. Paying them for doing more tests and surgeries creates bad incentives.
People and organizations other than doctors increasingly are assuming power to decide which medications to prescribe or procedures to undertake. More and more, decisions about personal healthcare are no longer made by the treating physicians in consultation with their patients, and based on the doctors' expertise.
As a clinician, I would never want to be coercive in relation to a patient, nor do I harbor the illusion that as a physician I am capable of forcing someone to change their behavior, no matter how detrimental to their health.
The early pioneers of both wellness and network marketing were motivated by the sense that it was possible to create a better life than the conventional routes offered - better personal health and better economic health, respectively. Now the 'alternatives' of yesterday have become the economic powerhouses of today and tomorrow.
I hear from patients who say their doctor said, 'If you want to take Vitamin C, go ahead and do it. It won't harm you, and it may do you some good.' More and more physicians are getting convinced about the value of large doses of Vitamin C.
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