[kazinator]

> doctors would be given a financial incentive to see patients within forty-eight hours.

Not measuring that from the first contact that the patient made is simply dishonest.

"Call back in three days to make the appointment, so I can claim you were seen within 48 hours, and therefore collect a bonus" amounts to fraud because the transaction for obtaining that appointment has already been initiated.

I mean, they could as well just give the person the appointment in a secret, private appointment registry, and then copy the appointments from that registry into the public one in such a way that it appears most of the appointments are being made within the 48 hour window. Nothing changes, other than that bonuses are being fraudulently collected, but at least the doctor's office isn't being a dick to the patients.

[DharmaPolice]

It may amount to fraud but in the context of that service, no record was kept of calls not resulting in an appointment. My wife was a receptionist at a GPs around the time the article mentions and in some cases it was worse than that - if you phoned and asked for an appointment, if they couldn't give you one within 48 hours they wouldn't offer one at all - telling you to call back later / the next day.

Although the New Yorker piece has leaned on the bonus angle the way it was discussed publicly was that doctors weren't allowed to offer you appointments outside the 48 hour window [0].

It was a very silly interpretation of the rules, but I think GPs felt it was too rigid and therefore stuck to the letter rather than the spirit.

0 - http://news.bbc.co.uk/1/hi/health/3682920.stm

[Eridrus]

It's really hard to design a not game-able metric. The problem here seems to be that doctors are under-provisioned for some reason, and so long wait times are a form of load shedding for the system. Without addressing this core issue, which individual clinics have little control over because they are generally boxed in by regulations over who can administer medical care, except to rush appointments (which they're probably already doing), there's not much they can do to solve the problem, so all they can do is try to game the rules or not get the bonuses.

[closeparen]

Doctors don’t get to bill for idle time. Being less than fully utilized is leaving money on the table. The idea here is presumably to compensate them for leaving gaps in their schedules.

[Eridrus]

What you're describing is effectively what doctors did: they left their entire calendar free until the last moment and only took appointments then.

It turns out this is not actually what people want; people want this availability to exist, but also do not want to be turned away if they book ahead of time, which points to this being a capacity problem, not a scheduling problem.

[ectopod]

Not to defend the system, but I don't think they were trying to fraudulently get her 48 hour payment. Rather, if they accepted advance bookings (which was, after all, the old system) then almost nobody would be seen in 48 hours. They could have offered advance bookings for follow-ups, but since most appointments are taken by the sickest people, many of them will be follow-ups, so this probably wouldn't have helped.

If you want to reduce the queuing time in a system you need to reduce the processing time (i.e. the duration of an appointment) or increase the number of servers (i.e. doctors). You can't do it by edict.

[bluGill]

On hindsight. However did you think of that before hearing of the problem. Even if you did, can you think of - without much time to think - how every possible metric I can propose on every possible topic.

Tony Blair was trying to solve a real problem that needed solving. That he opened a different problem is something that we should think of as normal, and not blame him for trying to solve the original problem. The question should be how to we change the metric until the unintended consequences are ones we can live with. That will probably take more than a lifetime to work out.

Note that there will be a lot of debate. There are predicted consequences that don't happen in the real world for whatever reason. There are consequences that some feel we can live with that others will not accept. Politics is messy.