Monday, May 14, 2012
Incentivizing for Quality Care
Yes, friends, I have been to the doctor. Not my doctor -- under our current "emergency" health insurance, it would have cost $120 to see him. The clinic downtown took me and my eldest for $40 each, plus a discount on the prescriptions we needed (inhaler for me, amoxicillin for the girl with strep).
I knew nothing about this clinic downtown until a friend recommended it to me when I explained why I was putting off going to the doctor for my cough until absolutely necessary. I was pleased with our care. The gentleman took plenty of time with us, listened carefully to my important backstory, even pulled out a big picture book to show us what he saw when he looked in our ears and how he knew we need to take Sudafed to drain our eustachian tubes. Nice guy. I suppose it remains to be seen how effective a doctor he is.
'Cause really, that's what it boils down to, right? I've been to doctors whom I loved -- who were very personable and attentive, who treated me with respect and compassion -- but in the end, they weren't able to effectively take care of my illness. Is this because I had some freakish kind of condition that eluded medical science, or because my doctor just lacked the knowledge or skill or perspective that he needed to diagnose it correctly? Just like I've had teachers who were friendly, fun and caring, but who couldn't figure out why this math concept wasn't clear to me and couldn't make it clear to me to save either of our lives.
Hubby heard a doctor on a call-in radio show talking about how, as health care is set up in our country, he really has no incentive to keep his patients healthy. Not that he -- or most doctors -- are trying to extend illnesses to make more money on the sick, but he said frankly, the system does incentivize them to do just that.
During the health care debates, I read an article about health care systems in other countries. There was one somewhere in Asia (I should have hunted that down before started here) where the doctors get paid for keeping you healthy. When you get sick, the assumption is that the doctor screwed up, and they fix the problem in you at no charge. I'm trying to figure out how that could work. Your health depends on so many things that the doctor can't control -- how you eat, whether you exercise or smoke -- I mean, he can make all kinds of recommendations to you, but if you ignore them, how can he be responsible for the results?
And again, I'm seeing the analogy to teachers. How can teachers be held responsible for the learning of students when so much of that learning depends on the students themselves, not the teacher? Yet, there must be a way -- a way to incentivize doctors and teachers fairly and effectively. What would that be . . . ?