• AcademyHealth: We need to pay for good things, not bad

    Many believe that one of the reasons that health care costs are so high in the United States is because financial incentives are misaligned. This is sadly evident in the way we pay for medical errors. That’s the topic of my latest piece at AcademyHealth. Go read!!!


    • Your point about who pays when things go wrong was brought home to me some years ago when a local mechanic misinstalled a part on my car, and when this was found provided the fix for free. Other craftsmen working on my house have done the same thing. The thing that caused this behavior was a power relationship. If the vendor was a small timer, the fix was free. When I dealt with a larger entity, the situation was different. When dealing with someone who has near monopoly power, you are screwed. This is the case with utilities, airlines, governmental agencies, and big-time medicine.
      Medicine has monopoly like powers over its clients. It does not operate in an open market where buyers and sellers meet on equal footing. In an ideal world, this monopoly power would be restrained by the ethics of professionalism. Unfortunately, this ideal world does not appear to be dawning immediately. The abstract models of economists do not appear to address these problems.

      • I second what oncodoc wrote. I think this is partly due to licensing 2rd party payment but I also wonder if it is this partly because medical care went from charity to what it is today and so we are less skeptical of the system than we should be.

    • While medical errors is a worthy topic, I’d also like to see more on billing errors such as incorrect coding, double billing etc. There was an investigative news story a while back that found that most hospital bills had at least one error, and more than 80% of those errors favored the hospital.

    • I was under the impression that the PPACA begins to deal with this.

      A friend is an oncology nurse at a US hospital and reports that the hospital under PPACA is no longer allowed to bill for treating hospital acquired infections. This makes life hard for her, because her patients are often immuno-suppressed and to attempt to reduce infection rates, the nurses have to go to great lengths when, say, inserting a central line.

      Suffice to say, IMHO, they should have been doing that before PPACA.

      Is this aspect of PPACA as significant as I hope it is? Has it shown any results yet? Does it cover more than just hospital-acquired infections?