On the Sunday talk shows, e of Team Obama’s mantras is that under government-run healthcare, payments to doctors will be made based on quality (outcomes) rather than the quantity of procedures being done.
Nice philosophically, but how to make it happen ?
Couple of observations:
- Quality over quantity should be easier in education than healthcare since students can be tested for progress. But, virtually all merit pay programs for teachers (i.e. outcome-based) have been rejected out of hand or fail. But, they’ll work in healthcare … hmmm.
- A common method for controlling output quality is to control input quality. In healthcare, that means rejecting the toughest cases and treating only the sure winners. For example, when I first investigated corrective eye surgery, the docs rejected me. My eyes were too bad, and they wanted to tout the percentage of patients that they got to 20/20.
- It’s argued that a key to controlling quality is to make primary care physicians the coordinators of all medical services. That’s silly because:
(1) there is a shortage of primary care docs (evidence: how quickly can you get an appointment when you’re sick? how about an appointment outside the 9 to 5 work day window?);
(2) been there, tried that – in the past, most plans required that a patient see a primary care doc to get a referral to a specialist – the referral was almost always given – net impact: a step was added to the process
- The Mayo Clinic — always cited as the model of outcome based systems — has stopped accepting Medicare in its Arizona facilities. Hmmm. Guess it didn’t drive costs down low enough …
I guess it’s better to bum’s rush through legislation than to give it serious thought. Disappointing.
The Homa Files 
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