Study: “Bundling” Payments to Doctors Didn’t Work
[A frequent complaint is] that paying fees to medical providers for each service may lead to unnecessary care… One of the fashionable suggestions for new-style payment is “bundling,” in which providers typically get a set amount that is supposed to cover an episode of care…
But a new study published in Health Affairs [gated, but with abstract] raises questions about the feasibility of bundling. The researchers, from the Rand Corporation and the Harvard School of Public Health, looked at three sites that were trying to implement a bundling methodology… In two to three years of trying, none of the providers or insurers actually made or received a bundled payment, or even implemented a contract to start them.
Full article on “bundling” to pay doctors in The Wall Street Journal.
I’m supposed to be surprised at this result?
Top down programs are unlikely to work — especially the first time they are tried. In other markets, fierce competitors have been designing ways to attract customers for as long as this country has been in existence. Walmart did not spring up in a day. It’s been around for around for more than 50 years in one form or another. It is successful due to constant experimentation and incremental improvement.
Health care would benefit from the same continual quality improvement over decades. It’s no wonder why one trial fails to deliver on its first try outside a competitive market.
Why would anyone think that anything dysfunctional bureaucracies do is ever going to work?