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Noveed Hussain

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Why not pay doctors after getting rid of disease...?

I was just that we should pay the fees of doctors after getting rid of disease or feeling better than before it will reduce the wrong diagnoses and doctors will pay more attention.

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  • Sep 28 2012: preventive health strategies have been in place in ancient times.
    in acupunture traditionally they used to have a system where - you paid to remain healthy. if one got sick, payment ceased & the practitioner had to return the person to good health before payments to the practitioner resumed.
    the good things about that are
    1. people get good preventive health & are encouraged by the doctor to remain healthy as he /she gets a good feed.
    2. sickness makes the doctor a pauper so its in his interest to practise good preventive medicine
    3. develops a completely new a paradigm for health - how to maintain health rather than worry about disease & concentrate on getting rid of disease
    4. it also emphasises how we measure health & clear parameters for defining health criteria.
    i would one day like to practise this philosophy & benefit from it.
    hope this helps
    anand
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    Sep 27 2012: In many ways, this is the way the capitalist system operates today in the United States. In general, once you choose a speciallization, you begin to work for a hospital, if you are a surgeon, you will have a mortality rate... or, they might have a different word for it... but the concept is almost exactly what you describe.

    Surgeons whose patients survive 95% of operations or better, are paid much better than those whose patients survive 85% of the time. Also, the few, who happen to have amazing hands, and operate at 99% and above adapt fame within the community they can then use to start an incredibly profitable private practice, or take a leadership position at a teaching hospital.

    It's not on a per person basis, but ultimately it's outcome based. Merit based pay, is the one fundament of capitalism I hope we never lose. In public and socialist models, often the pay is not as good for those who excel... At the same time, our system costs way more than most countries could ever afford, and in fact it's likely bankrupting us... However, the free market, would pay the best doctors, as well as it could, people are happy to pay great doctors.

    I think the solution is actually a bit simpler than you might imagine. You need a Pseudo Doctorate degree, that people can get online, at a library... A real degree, with real tests, but done without any experimentation. Something people can use to either become apprentices, or serve areas during crisis. This will limit the bargaining power of unions, but also help take the burden of simple problems off the social model. A Pseudo Doctor, can help you mend a broken leg, or diagnose a rash, simple things... helping the system, but still keeping them in check.

    This is totally an outsider perspective though, and I have no idea how possible it might be. Seems like it could be done cheaper than any other solution i can imagine though.
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    Sep 26 2012: Outcome-based payment is very tempting, but it seems impractical to me. Here are a few thoughts:

    - What about doctors treating injuries? Not all injuries can be totally healed.
    - What about incurable diseases?
    - What would motivate a doctor to take on difficult cases, if s/he was only being paid when someone felt better or was cured. Doctors would only be motivated to take on easy-to-solve cases.
    - Since many people in the U.S. are not the direct customer of their physicians (insurance companies are), how much sense does it make to give insurance companies even more control over the decisions made by a physician?

    Great question!
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      Sep 26 2012: Well, I really like the term outcomes based. Because if the outcome were identified in each of your thoughts and correctly measured.

      So lets take a physician treating heart disease. They would get a higher reimbursement if hospital visits were less than twice a year or something like that. Even if the patient was terminal, perhaps six visits per year.

      Or someone with a knee replacement, they would get higher reimbursement if the patient was free from infection and had a 120% increase in joint function as based on range of motion measures.

      It might actually work...
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        Sep 26 2012: Interesting point, Linda. This approach would certainly require a great deal of extra thinking about what metrics would be used to judge outcomes. Of course insurance companies would likely be the drivers of those metrics in the U.S., so I'm not sure how that would turn out.
  • Sep 26 2012: "Why not pay doctors after getting rid of disease...?"

    You've stumbled upon the holy grail of health care budgetting, but it's not that easy. How do you know your doctor didn't just patch you up temporarily to make it look like he cured you, how do you know the doctor ever had a chance of helping you (maybe your disease can't be cured)? How do you prevent doctors from ordering unnecessary tests to cover their own asses?
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      Sep 26 2012: Yeah John I know that some disease are not totally curable but after medicine we feel better in those cases.
      • Sep 26 2012: Symptom suppression is very profitable and not at all what you would want to strife for to make health care more efficient. It leads to drugs being given for imaginary ills and makes both preventitive health care and complete curing less attractive to whoever is making money off of drugs.

        @Linda

        Yes, it is pretty much the way things work in the US.
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    Oct 10 2012: This is great for simple medical issues like colds or other fairly straightforward issues. BUT it would provide an incentive for doctors not to treat the most severe cases, the most debilitating chronic disorders and the most challenging cases because those cases would involve more time to treat and evaluate. Doctors would then avoid specializing in more demanding areas or in areas where no clear cut answers exist.
  • Sep 29 2012: a good start to discuss this economic burden!
    I understand, that in the old China a doctors was paid when his patients stayed well. wo he was interested in their life style, nutrition, family issues, home environment etc - he was actually more a health teacher.
    in our economic environment there are not many people interested in us being healthy. Doctors, pharma industry, drugstores, health insurance companies all get rich when we are of poor health ;-)
    self responsibiity is the answer, i'm sure....
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      Sep 30 2012: Yeah Christina you are right that why a doctor will care us because if we are sick then his account will be credited with the money.

      I remember that my auntie got kidney transplantation but that was a failure due to doctors (I do believe) which cost her life. We just lost her but there was no loss of doctors because they already have received the money so I think ancient times should be come back and doctors should feel more responsibility.
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    Sep 26 2012: Because if they don't you'll be dead.
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      Sep 27 2012: I am not saying that you do not pay to doctors at all but on the condition that you have recovered.

      Suppose you are a civil engineer and you have a contract to make a bridge when you will get your payment ofcourse some may be in advance and the remaining after the completion and afterwards if it is found that you used wrong material or bridge has been broken then you might have a penalty or you may be send to the prison. Now think in the field of medical that even you are wrong diagnosed or the disease come back with more complications then what will you do??

      So its just an idea to pay doctors after satisfaction.
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        Sep 27 2012: if you want to clean up this. you must learn someting about medicial .!
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        Sep 27 2012: It seems your idea requires waiting to pay until time proves you are no longer suffering from the original medical problem. That waiting period is a problem. How much time must pass before you know the doctor has cured you? As I said originally, do we wait until you die and perform an autopsy to determine whether the doctor who treated you some years earlier should be paid?
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          Sep 27 2012: as far as what i have learned .i think we should do like this .
          one ; when you hav one item.then you pay one
          then you have another .you pay another
          you know we cant decide what the doctor do
          i think most of the doctors have tried their best .
          so my suggestion is learn as much as you can .then you can inspect .when you feel something wrong you can stop it just as what i said brfore
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    Sep 26 2012: Doctors have to be paid. No doubt they have to be well paid. But doctors should be motivated by the impact of their services; by the desire to nurse the sick back to health and by the care and concern for the well-being of patients.

    If a doctor is not first of all passionate about his or her profession; even more money would not bring out the best from such an individual.
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      Sep 26 2012: Feyisayo I am agree with you but now I will like to tell you the situation in our country...

      Every year when the financial year is going to start the doctors who are government employees do strike to increase their pay due to which our country especially the lower income class get affected and the awful thing is this that they even close OPD and emergency centers during the strike which sometimes cause a lot of people death. You may be astonished that the pay of doctors is more than the government employees who are in same grade but they are in police, civil services or in education department etc.

      Their pay is good enough that they can lead good life but still they have private clinics where they serve after government duty with high fees. When they are on the duty I have noticed and listened through different sources that they do not pay their attention. I witnessed that one doctor who was US graduate working in a local hospital asking his colleague to pay his duty because he have to go on a date with his girl friend.

      So due to these reasons I was just thinking that doctors must be paid after they cured they diseases.
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        Sep 26 2012: I think doctors need to be well paid. Maybe the government has not given much consideration to the welfare of doctors.

        Doctors have to care and make sacrifices; but they also have bills to pay and families to take care of.