Monday, May 14, 2012

Incentivizing for Quality Care

I took an ambien last night -- my first in 2012.  This reactive airway disease is doing me in.  It's actually improving some, I think, but last night I felt, if I could just get a full, deep night's sleep, everything would turn around for me today.  We'll see.

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 . . . ?


John said...

Good question Gwen. I got out of engineering and have been in healthcare for the past 4 years with a "sub-specialist" surgeon. He doesn't just work on the eye but only on the retina of the eye. We run a full busy clinic just trying to keep people seeing a little longer when they have a age related disease that has no cure. Once we start seeing them, most of them we see for the rest of their lives some as often as every 4 weeks just trying to keep them from going blind. We have to buy the drugs we use for treatment and then get reimbursed from 200+ insurances all with different rules, allowances, and with different deductibles/copays, etc. for each of their patient plans. In 2011 I purchased $3 Million worth of drugs on an American Express and then had 60-90 days to pay for it. It's a choreographed explosion of paperwork and computer filing. And you're right, we can do all we can for these people including advising on weight control, exercise and smoking but it's obvious most ignore us and just keep coming back for more treatments. Then they complain about their deductibles and the lack of progress on improving what sight they have already lost. It's a discouraging business that we on the administration side are running. I'm glad I have skills outside of medicine when the time comes.....

GJK said...

My husband commented that, as long as someone else (insurance, government, whoever) is going to pay for their healthcare when the long-term consequences of their behavior finally come, many people will have no incentive to change their behavior. Only when they realize, my fat consumption is going to cause health problems that could BANKRUPT me, do they have an incentive to change how they eat. But then, to not give health care to someone who can't afford it is uncompassionate -- even when they wittingly brought their illness upon themselves. The whole thing is just a mess.