This is the wrong incentivization model because it means physicians will do everything to treat the symptoms and not even bother diagnosing the causes.
We already have a pain killer epidemic, and that would make it worse.
You can't cure what you don't know exists, but you can cure that admitting abdominal pain with painkillers and still get paid (with that model).
The point is that diagnostics are expensive, and if you're not going to be reimbursed to run them, you're going to take the risk to find the cause. What's left is curing the symptoms.
Insurance companies are incentivized to not pay anything.
They currently demand that patients do not even go to a hospital, hence the price penalties for going to an ER and lack of preventative care coverage. The only thing an insurance company will demand is what they currently do - the lowest cost, which is an Rx for pain pills.
So if you join a company with terrible infrastructure that needs a ton of work, you don't get paid until it's operational? What if there are organizational issues within the company that prevent you from actually resolving things long-term? Rarely is a single engineer empowered to make a difference in the up-time.
Physicians face similar challenges when it comes to the bureaucracy in the world of medicine, but with the added challenge of working on the unpredictable biology of human beings rather than a bunch of transistors that are predictable in their behavior.
And imagine if the system was setup in the way you suggest, which doctor in their right mind would take on patients where the treatments aren't as clear cut? Who wants to work for months or years with no guarantee of pay?
Honestly, comparing the two fields is pointless. I do not envy physicians. They are working within a broken system and most are doing the best they can. Blaming them will get us nowhere.
Medicaid and medicare are switching to a value based program, where hospitals and providers are paid more for better outcomes instead of the previous pay for service model where they are effectively incentivized to over treat, and not fix the root cause.
Yes. The check will be in the mail upon receipt of a death certificate. But the form is at the confusion level of a stripper with a W4. Also for some reason we are going to have the postal service manage the reimbursement.
The Chinese healthcare model -- you pay the doctor when you're well -- is an alternative approach. (The doctor is obliged to try to get you well again.)
Congratulations, you've ensured surgeons don't undertake complex surgeries, oncologists pick and choose the less critical cases, and no one staffs hospices any more.
I agree. I think it kind of happens now when surgeons are ranked on their success rates. They start refusing complex surgeries that might impact their ranking.
A number of states allow nurse practitioners, or physicians assistants to do many of the things that only doctors can do in most states, practice independently, admit patients, prescribe medication. But they do not need to go through the match process and residency, so there is not the same kind of monopoly
Nurses and PAs are similarly limited by available slots in their respective educational programs. Our local community college has a 4-5 year wait list for their RN program, as an example.
In both cases, there's a limited number of slots available for what's fundamentally a required educational program, and increasing that number of slots is difficult on a structural and staffing level.
There is no set limit like with the match or residencies. New schools can open up, existing schools can increase class size or run additional classes to match demand, and they have the incentives to do so.