When it comes to steering human behavior on a macro level to produce a socially desirable outcome, there are a couple of options:
1. Appeal to people on an altruistic level
2. Offer them economic incentives
Ask any economist, and he or she will say the latter option is a better bet.
When we seek medical treatment, we don't usually think about the incentives motivating our doctors. We assume, perhaps naively, that our health is of paramount concern--that our doctors genuinely want us to be healthy. Because why else are they practicing medicine?
What if our health isn't always at the top of their list of priorities? What if the incentive structure in medicine rewards doctors who don't take good care of us?
Recently, Mary Joe Feldstein, a writer for the St. Louis Post-Dispatch, suggested just that:
Typically, physicians get paid only when their patients receive care, and more complex care often brings bigger paychecks. At the same time, doctors complain that paltry payments for office visits force them to rush through checkups instead of educating patients about their illnesses, medications and healthy living - all of which might lower future medical bills.
It's a system that gives doctors little financial incentive to keep patients well. And, experts say, it might be contributing to dangerous, unnecessary care as well as high medical bills.
Scary, isn't it?
The good news: there are people who realize the system needs to change, and they are busy devising a way to provide the health care industry with incentives to keep us out of the doctor's office.
According to the Post-Dispatch article, the federal government's experimental Medicare Advantage program is an effort to fix the incentive structure. Under Medicare Advantage, the feds pay private insurers a per person rate. The money is spent on whatever care the patient needs, and the remainder is pocketed by the insurance company. Thus, the healthcare industry has an incentive to put its time and energy into checkups, patient education and preventative care, which are cheaper and lesson the likelihood of major treatment later on.
"The hope is that the plans will encourage better management of illness to avoid expensive flare-ups," Felstein explains.
Wait a minute, you say, if the insurance companies can keep any unused money, doesn't that give them an incentive to convince patients to forgo any kind of treatment--necessary or not?
There is that risk, but, as a source quoted in the article points out, that scheme would probably backfire; the patient would likely get frustrated with the lack of care, or would get sick enough that he would require really expensive care--something insurers would try to prevent.
As much as we don't like to believe it, doctors and health care professionals are like the rest of us--that is, they're human and respond to incentives.
[Hat tip]: The Health Care Blog