[hrktb]

Is there a need to attribute to malice when all the incentives are stacked against the correct behavior ?

Poor communication partly occurs because at no point does the Clinic have to go against its interest, there is that much less friction in the decisions taken.

Ethics is an issue but it seems that wouldn’t be sufficient as a focus for a solution.

[luddaite]

I agree that the monetary incentives are definitely incorrectly aligned in the current healthcare system as is. That said, I don't think that monetary incentives are the only incentives present here. Most physicians don't go into medicine only to make money. There are easier ways to make more money. From my experience, most healthcare providers genuinely care about the patients' well being. That is why I bristle whenever people rush to attribute a physician's actions to greed. I totally agree with you that a better incentive structure would improve the system.