A Quote by Richard Thaler
Doctors and hospitals should be paid for keeping their patients well. Paying them for doing more tests and surgeries creates bad incentives.
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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.
Hospitals should be paid to keep patients out of the hospital, not for signing up more and more patients.
There is survival behavior, and doctors need to learn from patients who do not die when they are supposed to, instead of saying, 'You're doing very well, so keep doing whatever you are doing.' They should be asking what their patient is doing and pass the information to other 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.
Today we have a health insurance industry where the first and foremost goal is to maximize profits for shareholders and CEOs, not to cover patients who have fallen ill or to compensate doctors and hospitals for their services. It is an industry that is increasingly concentrated and where Americans are paying more to receive less.
Doctors should recognise the importance of the five human values; Truth, righteousness, Peace, Love and Non-violence. Love is the basis for all the other values. Doctors can infuse courage in patients by the love they show towards the patients. If doctors carry out their duties with love they will be crowned with success.
There is among doctors, in acute hospitals at least, a presumption of stupidity in their patients.
I don't think the people today who start hearing voices, stop eating and sleeping, and run amuck are likely to get good treatment. Having more knowledge, better diagnostic capabilities, better medications with fewer side effects, can't make up for the fact that most patients are being treated by doctors, therapists, and hospitals, who are operating under constraints and incentives that reward non-treatment, non-hospitalization, non-therapy, non-follow-up, non-care. Lost to follow-up is the best outcome a health insurer can hope for.
"There are one or two elementary rules to be observed in the way of handling patients," he remarked, seating himself on the table and swinging his legs. "The most obvious is that you must never let them see that you want them. It should be pure condescension on your part seeing them at all; and the more difficulties you throw in the way of it, the more they think of it. Break your patients in early, and keep them well to heel."
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.
A central notion in the Affordable Care Act was we had an inefficient system with a lot of waste that didn't also deliver the kind of quality that was needed that often put health care providers in a box where they wanted to do better for their patients, but financial incentives were skewed the other way... We don't need to reinvent the wheel; you're already figuring out what works to reduce infections in hospitals or help patients with complicated needs.
I'm a businessperson. I did really well. But I have common sense. And I said, well, I'll tell you. I haven't given lots of thought to NATO. But two things.Number one, the 28 countries of NATO, many of them aren't paying their fair share. Number two - and that bothers me, because we should be asking - we're defending them, and they should at least be paying us what they're supposed to be paying by treaty and contract.
I've never had it so good in terms of taxes. I am paying the lowest tax rate that I've ever paid in my life. Now, that's crazy. And if you look at the Forbes 400, they are paying a lower rate, accounting payroll taxes, than their secretary or whomever around their office. On average. And so I think that actually people in my situation should be paying more tax. I think the rest of the country should be paying less.
Americans need health care focused on them, not Washington. They want choices, not more mandates. They want affordable plans with ready access to local doctors and hospitals - not high-priced plans with doctors they don't know.
Medical costs are soaring because our health-care system is totally screwed up. Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.
We don't have a business model for health care in this country, We just have a business model for care. The way doctors and hospitals get paid is something bad has got to happen. It's a pure reactive model.
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