Wake-up Call

Resist the Corporate State

The hidden public-private cartel that sets health care prices

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greedIn all the hysterical and industry-directed uproar over health care, few if any conversations focus on the systemic problems which underlie why we spend so much and get so little (other than heartbreak and frustration) from our health care system.

Darshak Sanghav has an article in Slate which details the payment bias which has driven so many into lucrative specialties while a growing number of Americans can’t find a primary care doctor:

We must address the perverse financial incentives that created and continue to inflame {the shorage of primary care doctors}.

The root of the shortage can be traced to 1985, when a Harvard economist named William Hsiao developed a scale to measure the relative value of every single one of the thousands of services provided by doctors, a job later comparedto measuring “the exact amount of anger in the world.” For example, Hsiao’s team deemed that a hysterectomy required 3.8 times more mental effort and 4.47 times more technical skill than a psychotherapy session. In 1992, Medicare formally adopted Hsiao’s concept; private insurers followed suit. Today, this relative value-based system sets the prices—and therefore drives the priorities of American medicine.

…..It’s clear that Medicare and all major insurers place far more relative value on fancy procedures like stents, EKGs, skin biopsies, CT scans, and bowel clean-outs than they do on actual face-to-face time with patients. Procedures, they have decreed, require more mental effort and skill than seeing actual people. The implications are obvious.

……And, obviously, specialists make more money than primary care doctors. (Even trainees grasp this; recently, only a single graduating internist out of a class of 50 residents at Massachusetts General Hospital planned to become a primary care doctor.)

Fundamentally, the entire payment model of American health care drives medical centers, doctors, and hospital managers to push for more fancy procedures at the expense of primary care doctors. 

read entire article

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Written by laudyms

September 2, 2009 at 1:19 pm

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