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Joined: 22 Mar 2008
Posts: 1630
Location: Grand Forks

PostPosted: Sat May 30, 2009 3:32 am    Post subject: Health care Reply with quote

There's a long but very interesting article in the most recent New Yorker magazine entitled The Cost Conundrum: What a Texas town can teach us about health care.

In summary, it argues that the cost of health care in America is largely a cultural phenomenon. Doctors get paid per treatment. Their income is based on how many tests, examinations, and treatments they perform, and so there is a financial incentive to order tests, examinations, and treatments even when they are not actually necessary. In some places (the writer examines McAllen, Texas), it has become socially acceptable among doctors to treat patients as profit centers more than people. And so costs skyrocket. In other places that kind of behavior is not socially acceptable among doctors. For example, in Grand Junction, Colorado, the doctors in town formed an association where they review one another's patient portfolios on a regular basis in order to identify ways to lower costs and increase quality of service. And so costs go down.

The writer is a physician himself, and seems to have done substantial research in producing this article. Very interesting. His most interesting point was that in a system which pays physicians per-procedure, it doesn't matter who pays the bill. The financial incentive to over-prescribe would exist regardless of whether the payer is a private health insurance plan or a government program.

Because the problem is a cultural phenomenon, it's going to be fiendishly difficult to change, too.

I'm curious -- all you forumites who live in countries with universal health care, how are your doctors paid? Do they get set salaries? Paid by the patient? Paid per procedure? By the hour like lawyers? How does it work for the physician?
Keeper of The Remnant Minuon (cognomen Lucy, the Eaten One) and the Emissary Caeli
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Joined: 23 Mar 2008
Posts: 650
Location: Cardiff, UK

PostPosted: Sat May 30, 2009 4:28 am    Post subject: Reply with quote

Depends hugely on the doctor. In some cases, there is pay by procedure or pay by patient - some GPs are paid like this in part, and a number of vaccinations are done this way too - they're paid by the dose, and the practice buys them. But the way GP practice work is complicated and confusing, as are dentists and opticians, and all of these vary depending on your NHS Trust.

But most medical staff in the UK are salaried annually. The NHS is the biggest single employer in the country by a long way. And I'll be getting a job with them once I graduate...

Medicine is free at point of use, and does not rely on insurance (though you can go private, and the private healthcare system in the UK works basically the same way as the US system I believe). Unfortunately, this system does tend to wind up horribly inefficient and jammed with beauraucracy. But IMO it's better than the alternative for people who are in the most need.
Keeper of Tristram's rings, and Felucca's very expressive ears.
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Joined: 23 Mar 2008
Posts: 258

PostPosted: Sat May 30, 2009 6:11 am    Post subject: Reply with quote

Similar to something I saw the other day: A guy was being paid to speed read...by the hour. Very counter-productive. Yet too often our culture arbitrarily creates those silly situations...and then runs with em.
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Joined: 14 Apr 2008
Posts: 1392
Location: Back in the Shire.

PostPosted: Sat May 30, 2009 7:22 am    Post subject: Reply with quote

I can give you the dental NHS system lowdown last time I knew it (before my dad was pretty much forced to go private). There is a big misapprehension that most dentists in the UK go private to get more money. In my dad's case he went private because you couldn't do a good job on the NHS anymore. They started allocating time for treatments so 5 minutes for a checkup (when to do a good job you really need 10) and they started allocating pay by the number of sessions the dentist did. So for example, if a patient needed three fillings it was more profitable for the dentist to book them in for three different appointments instead of getting them all over with in one. It tore my dad apart because he became a dentist because he believed in the NHS and it killed him to have to get out. The hate mail didn't help either.
He who does not eat cheese will go mad. ~ French proverb.

Keeper of the fallen leaves. 'Cos they're still pretty.
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