Another Problem with Third-Party Payment

We’re encouraging addiction! I’ve never understood why so many health policy types so resolutely defend the idea of third-party payment. Isn’t it obvious that providers paid by third-parties will have an incentive to maximize against the payment formulas rather than serving as agents of their patients? Here is more evidence from Austin Frakt (who does not draw the lesson I am drawing here):

Sixty percent of the opioids that are abused are obtained directly or indirectly through a physician’s prescription. In many instances, doctors are fully aware that their patients are abusing these medications or diverting them to others for nonmedical use, but they prescribe them anyway. Why?

Among the reasons she provided are: “[t]he ‘all suffering is avoidable’ ethos” and that “it is faster and pays better to diagnose pain and prescribe an opioid than to diagnose and treat addiction.”

Comments (12)

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  1. Alex says:

    It seems like the easiest way to satisfy your addiction to being payed is to make someone an addict to something you provide.

  2. Ken says:

    Of course Austin didn’t draw the same conclusion you did. He believes in third-party payment.

  3. Paul says:

    Why solve the problems with the system when you can just drug everybody up and get paid to do it?

  4. Robert says:

    Alex, do you really think it’s strictly the doctors’ fault? I believe the pharmaceutical companies play a bit of a roll in getting you hooked on their products.

  5. Laquisha says:

    How is Frakt’s polls even correct, if someone is addict to opioids are they really going to publicly admit it?

  6. Linda Gorman says:

    “In many instances, doctors are fully aware that their patients are abusing these medications or diverting them to others for nonmedical use, but they prescribe them anyway.”

    Really? How do the researchers know that? And what, exactly, constitutes “many instances?” How about the patients who claim that overly strict rules for prescribing make access to adequate pain meds very difficult?

    Is this backed up by anything or is it just another example of deploying a casual smear to undermine respect for physicians?

  7. Don Levit says:

    Insurance coverage, particularly if it is 100% or close to it, arbitrarily drives up the prices.
    What normally would be unaffordable by individuals suddenly becomes affordable due to third-party payment.
    The prices negotiated by insurers are so much higher than what would be negotiated by individuals.
    What individual would pay $1,500 for 30 minutes of treatment in the ER?
    We need to get third-party payment out of the center of insurance, and much more over to the periphery.
    We need to incentivize people who do not make claims (either by paying out of pocket, liquidating investments, borrowing, etc).
    They should have higher deductibles, and have a source of funds available to pay such deductibles, if needed.
    Don Levit

  8. Jimmy says:

    @Robert… How are pharmaceutical companies at fault? Are you saying they add addictive properties unnecessarily?

  9. Laura says:

    This is so wrong and unethical in so many ways. Physicians are not only aware of the fact that their patients are abusing and misusing their medications, but their are contributing to this horrific reality. They keep prescribing these patients knowing what they do with these drugs “behind doors”, and they end up affecting not only them, but whoever else ends up having access to these drugs. I wonder if there is any ethical professionalism left anywhere…

  10. Ashley says:

    I’m with Linda, these qualitative judgement aren’t backed up by evidence.

  11. Buster says:

    Some of the people who seek opioids are in paid and need relief. However, many others are addicted to them. But I suspect many people seek opioids because 1) it costs them little if anything; and 2) they can be sold for a tidy profit.

  12. Jordan says:

    Jimmy, I seriously doubt that he meant they’re making opioids MORE addictive. Perhaps they have influenced the culture to over-prescribe. Considering their lobbying schemes — or stories of testing abroad, it sounds plausible.