I found this op-Ed in the New York Times very interesting. You should read it all. Recall that on the one hand we want patients to be consumers, to shop for the lowest cost health care (without any viable tools assessing quality) and to this end plans are raising deductibles and out-of-pocket costs.
On the other hand as this article shows, we are providing incentives and penalties for providers to act in certain ways, ways that may save money, but may also force patients into a one size fits all.
All this will put a tremendous strain on physician integrity, on patient-physician relationships and on the balance between costs and quality health care; whatever that may be.
WHEN we are patients, we want our doctors to make recommendations that are in our best interests as individuals. As physicians, we strive to do the same for our patients.But financial forces largely hidden from the public are beginning to corrupt care and undermine the bond of trust between doctors and patients. Insurers, hospital networks and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctor’s decisions.
Contracts for medical care that incorporate “pay for performance” direct physicians to meet strict metrics for testing and treatment. These metrics are population-based and generic, and do not take into account the individual characteristics and preferences of the patient or differing expert opinions on optimal practice.
For example, doctors are rewarded for keeping their patients’ cholesterol and blood pressure below certain target levels. For some patients, this is good medicine, but for others the benefits may not outweigh the risks. Treatment with drugs such as statins can cause significant side effects, including muscle pain and increased risk of diabetes. Blood-pressure therapy to meet an imposed target may lead to increased falls and fractures in older patients.
QUINNSCOMMENTARY 