Wednesday, May 18, 2005

So, How Much Do You Tip Your Doctor?

We routinely tip our waitress at the local diner, and our barber…er, uh Hair Stylist, even the pizza delivery guy. But how much do we tip our physician when we’ve recovered from the surgery, or just stayed healthy?
Of course, I ask this with tongue firmly in cheek, but I was prompted to bring this up because of an article over at Fox News. Apparently, physicians who participate in the “Bridges To Excellence” program are eligible for cash bonuses based on the health of their patients.
The idea is that, if docs can keep their patients healthy, they’ll lower overall health care costs. Which makes sense. Of course, it hearkens back to capitation plans (e.g. staff model HMO) which actually penalize physicians who have negative outcomes. This approach has had mixed success; apparently sticks don’t work as well as carrots.
As one can imagine, not everyone who learns about this arrangement is a fan:
"It's disturbing that the only way we can get physicians to do the right thing for their patients is by paying them money."
So says Arthur Levin from the Center for Medical Consumers, a non-profit advocacy organization active in both statewide and national efforts to improve the quality of health care.
I find this kind of naiveté refreshing, if misplaced. Last I looked, physicians are human (well, excepting EMH, for all you Voyager fans), and respond well to financial incentives. What difference does it make “why” a given doctor is motivated to keep his patients well? What’s important is that his are.
There is one valid concern mentioned in the article, but it seemed as if it was an afterthought, and wasn’t fully explicated: “Critics fear an incentive program may encourage doctors to treat only the healthiest patients in order to get the financial reward.” Isn’t that the same argument, though, that critics have lobbed at Consumer Driven Health Care? I’m not saying it isn’t true, but I would love to see some facts to support the thesis.
Interestingly, Medicare is testing this out, as well. That’s promising: anything that would potentially help lower the costs of Medicare can’t be all bad.
Interesting idea, and I’ll be keeping an eye out for more information on it.
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