Should Doctors Decide if Your Health Care is “Worth It”?
This is Aaron Carroll:
I’m truly conflicted here. Like any good “economist”, I’m worried about future health care spending. I know that fee-for-service just sucks, and that the financial incentives for practice are totally misaligned. But I remain totally skeptical about pay for performance (see this, this, this, this, this, this, and this). I don’t see much evidence that programs like that work, and I don’t believe that the things we can measure are necessarily the same as how we’d ideally define quality.
I’m also concerned with making doctors the ones responsible for deciding what’s “worth it.”
Doctors can provide suggestions. Since they get money from your insurance, we have to be cautious due to such interest.
I agree. If we were to let doctors decide whether a particular course of action was “worth it,” decisions not in the best interest of the patient could occur.
I’m sure it would be worth it for the doctor, it could lead to a down payment on his new beach house.
There is too much room for the abuse of more misaligned incentives with the physician.
Agreed. Just like we can not let the government to control the army and the supreme court, a doctor’s job is taking care of patients, nothing else.
The decision should always lay upon the patient and the patient’s family. Doctor’s guidance should be valued in high regard, but guidance and suggestions is where the buck should stop.
Perhaps both parties shouldn’t be held 100% accountable.
True. Just as providing health care is not based on the efforts of one person, neither is deciding on the course of action in regards to value or cost of care.
“I don’t think it’s realistic to think this person should be the one who needs care right now. I also don’t think it’s always realistic to think it should be his or her physician.”
It also shouldn’t completely fall on either party either. When taking in consideration value and cost, both parties should come to mutual agreements.
What doctors need to do is present the various options, and discuss the possible outcomes. For instance, is it less costly to do physical therapy than surgery for a certain condition, and will likely have a similar outcome. Ultimately, the patient should be able to decide what’s worth it. Keep in mind, if the patient isn’t paying directly, they may decide everything is worth it.
I also agree, we have to be very careful about incentives for physicians to either overdo or underdo.
“But there’s no good way to make it an individual’s responsibility to determine what is cost-effective for their child. That hardly seems “ethical”. I’m not sure asking doctors to do it is such a good idea either.”
There is no good way to shift responsibility of the well-being of a patient to anyone. Which is why policies are in place to minimize the tough decisions, especially with cost of care.
The problem is not fee for service, it is third party payment. Fee for service works fine everywhere else it is used.
As for who should decide? The person who should decide how much to pay is the person who is paying. That is probably not you, that is probably the government or your insurance company. Sucks huh? Don’t like the idea of a faceless entity deciding how much your life or your quality of life is worth? Congratulations, you may be a libertarian, and your enemy is the third party payment system.
I personally think patients should decide what care is “worth it” and what care is wasteful. Of course, for that to happen efficiently patients have to control their own dollars and make uncomfortable trade-offs. But once patients ceded that control to third-parties by adopting insurance, they began to lose that option.
The third parties definitely disrupt the patient-physician relationship, in more ways than one.