[mdpopescu]

As a general rule, the entire medical profession has the incentives set up the wrong way - the more problems you have, the more they benefit.

I have read that there was a time, in the distant past, where you paid a doctor only as long as you were healthy. I can come up with some problems even in that case, but I can't help but think it might still be an improvement over the current situation...

[bipson]

Except that it is simply not true - the world is not that simple.

There are several incentives at play for a doctor.

Obviously there are different fields, and dental is slightly weird compared to the others, but first of all, doctors are trained to help and learn cures.

A doctor that keeps you sick instead of healthy is quickly out of a job (or out of patients, if you prefer). There are other doctors you know, and there is word-of-mouth, and ratings etc. There is no world-wide conspiracy of dental workers to keep you from getting a specific cure. Aka: Game Theory.

And an easy way to get rid of this would be if the doctors would be paid to keep you healthy:

So you pay as long as you are healthy, e.g. a valuable work-force. Hmmm, I wonder if you could just use income tax to fuel this...? Oh, we just invented universal health care, didn't we?

[bluGill]

Or even private insurance. There is a reason many insurance plans send you exercise right reminders all the time: healthy people cost less to ensure and so make more money.

[raducu]

There's overwhelming evidence against such a broad statement.

There are good mechanics, cars are getting safer, cops do fight crime, soldiers do fight wars and so on, social workers so do their jobs, teachers usually teach and so on.

You can say the same for every kind of work -- that you are incentivized to do a poor work so that there's more demand for the work, but the counter incentive is the free market.

If others can do a better job than you and eat your lunch, they will.

[mdpopescu]

> ... but the counter incentive is the free market.

Yes. Which is why the free market is ILLEGAL in the medical system, in the police system, in the educational system, in the judiciary system...

[dennis_jeeves]

Lol, how do you manage to keep your sanity on HN? Everyone else thinks that medicine/police/education/judiciary is so special that the free market cannot deal with it.

[mdpopescu]

It's difficult :)

[jjk166]

> There are good mechanics, cars are getting safer, cops do fight crime, soldiers do fight wars and so on, social workers so do their jobs, teachers usually teach and so on.

But there also exist many mechanics who try to get you to pay for unnecessary services, which mechanics are incentivized for.

Cars are getting safer for their human passengers by increasing the energy absorbed by the car body, which coincidentally increases the odds of a car being totaled in an accident, which increases demand for cars, which is what car manufacturers are incentivized for.

Cops are incentivized to make lots of arrests - which means they mostly fight crime which doesn't require extensive investigation nor poses high risk, ie lots of low level non-violent crimes.

Soldiers are not incentivized to prolong wars (they get paid in peace time, which also has much lower risks of death and disability). Major defense contractors and some politicians though do have an incentive to prolong wars, and coincidentally the US has been continuously at war for nearly 20 years.

How many major cities have had a serious social problem eliminated by the efforts of social workers? That's not their job, which is why it doesn't get done.

Teachers have no perverse incentive not to teach, they don't get paid more if their students don't pass. In fact it's a real problem where schools that have poor performance for unrelated reasons get punished with reduced funding, leading to a downward spiral that has destroyed lots of inner city schools. Even if the government doesn't formally have such punitive measures in place, the fact is wealthy families move away from mediocre school districts, which reduces the funding available for them, which quickly leads to the school district becoming even worse.

Perverse incentives don't mean you're incentivized to do your job poorly, it means the job you're incentivized to do well isn't necessarily the one people would want you to do.

[seer]

I think I’ve read somewhere about this being an old Chinese tradition. They would pay doctors for the amount pf people he is looking after, and he has the incentive to keep his “flock” healthy as that would mean much less work for him.

[inter_netuser]

It is common today too.

https://en.wikipedia.org/wiki/Capitation_(healthcare)

[zulban]

> the entire medical profession has the incentives set up the wrong way

Now seems like a good time to remind everyone that the world is not the USA. Most developed countries don't treat medicine as a for profit business.

[matheusmoreira]

As a general rule doctors always do what they believe is best for their patients. I don't think I've ever seen one intentionally harm patients in order to keep them coming back. There are so many people in need that doing such a thing would be pointless anyway.

[kleiba]

there was a time, in the distant past, where you paid a doctor only as long as you were healthy

This sounds implausible, and even if it were true it would not be very fair: it's usually not the doctor's fault when you've got some medical issue, so why should s/he suffer from that financially?

[Tade0]

Also it creates a major incentive to disregard diseases.

What follows is that a dead patient, while not a source of income, is at the same time not a source of costs.

I don't see how such an arrangement could work long-term.

[_0ffh]

Right. I think I remember it used to be normal in some societies to pay the doctor only if he managed to cure you. That sounds much more plausible. Paying for the state transition from sick to okay should work just fine.

[bluGill]

The problem is if you can't be cured but can be helped. Diabetes is an example of something where with medical care you can live a long life, even though we can't cure you; but without help you are dead quickly.

[Guillaume86]

It's worse than saying we should only pay devs the days there's no bugs in production, doctors can't decide to magically prevent diseases from existing or accidents to happen.

[mdpopescu]

Huh. Almost as if a company would provide a guarantee and only get paid if they kept the servers running for at least 99.999% of the time.

Weird, huh?

[CA0DA]

Look up "medicare accountable care"

Edit: I did it for you:

"An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care"

https://en.wikipedia.org/wiki/Accountable_care_organization

[k__]

When I look at the prices for recurring preventive health measures in dental, I don't think this is 100% true.