Saturday, March 13, 2010

Economic Incentives For Misconduct.

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Economic Incentives For Misconduct

Dear Friends:

A recent article from the Associated Press (brought to us by Yahoo! News) indicated that U.S. doctors may well be overtesting and overtreating. In the article, there is some conjecture that 1) doctors may be overtesting on the "side of caution," as part of their practice of medicine, and that 2) patients may be demanding more and more tests and procedures because of  a sort of "cultural overcaution." I suspect that this latter may be correlated positively with the increasing frequency of pharamceutical company ads in the media, and the increasing opportunism on the part of the legal profession to advertise all manner of bonuses which we can collect if we have any sort of adverse health issue -- the John Grisham class action "mesothelioma" and "asbestosis" phenomenon.

Perhaps the incentives for this overtesting and overtreating protocol stem from simple economics - if a third party (i.e., my healthcare insurance company or Medicaid) is willing to pay any bill which it receives from any physician without question, I might (as a hypochondriacal patient) seek out tests and procedures because there is no financial incentive for me not to do so. My physician (ordering up a gauntlet of tests and a barrage of procedures covering bunion to brain) is given a financial incentive (someone will pay!) to engage in this type of "defensive strategy."

If both patient and physician were given financial incentives for maintaining a state of health or wellness, I'm willing to bet my next CT angiogram that several things would happen:

1. Healthcare costs would decrease;

2. The number of tests and procedures would decrease;

3. The health of the entire US population, on average, would increase.

Human behavior is incentive-based. Our actions, particularly in the industrialized nations, are princiaplly governed by economics (running the gamut from survival to unbridled greed) and fear.

The referenced news item follows for your review:

A thought: Perhaps the U.S. Healthcare System is truly in need of a fiscal colonoscopy instead of crutches and bandages.


Douglas Castle

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Terms, Labels and Tags: healthcare systems, incentives for misconduct, economics and healthcare, health insurance, third-party payment, behavioral psychology, wellness versus testing and treatment, colonoscopy.

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