Interesting Medical Idea

[JimW1949]

My wife has a really bad cold. She started with a cold, then developed pneumonia. She got over the pneumonia, and now all she has is a really bad cold. This has been going on for well over two weeks now. We are now both retired so it isn't like she is missing work or anything like that, but still, it is a real pain to have a terrible cold. And to make matters worse, now I have a bad cold too, so we are pretty much stuck to the house.

Anyway, I was thinking about something. I know there is no real cure for the common cold, and having had pneumonia certainly didn't help any either. But the thing is, as a general rule of thumb, if someone becomes ill and goes to see the doctor, what incentive does the doctor have to make you well right away? What I am getting at is, if you are sick, either you or your insurance company are paying the doctor. When you get well yo stop going to see the doctor and at that point the doctor stops getting paid. So what incentive does the doctor have to make you well real quick?

Now don't get me wrong here, I am not saying doctors are crooked and are trying to keep you sick for as long as they can so they can make more money off of you. All I am saying is, there is less incentive to make you well quickly than there is to take more time to get you well. The longer it takes before you get well, the more times the doctor sees you, and the more times he gets paid. I have no idea whether doctors see it this way or not, but regardless of how doctors view it, this is the reality of the situation.

Now think about this for a minute, what would happen if everybody paid their doctor when they were well? Then, when they get sick, they stop paying their doctor until they get well. Now the doctor has a rather big incentive to get you well as soon as possible. The sooner you are well, the sooner you start paying again.

I have no idea if this "pay your doctor when you are well" type of system would work out or not, there may be some complications to it, but it is just something I thought about because my wife has been fighting this cold/pneumonia thing for awhile.

P&N -> ATOT at the request of the OP
-Schadenfroh

 

[JimW1949]

I meant to post this in the "Off Topic" thread. I screwed up and put it here. My apologies to the Moderators. Please move it for me.

 

[xj0hnx]

The problem with that is, you aren't the only person your doctor sees.

 

[Gooberlx2]

Yeah, doctors are not hurting for patients. There's way more demand than supply. In that way, there's much more incentive for them to treat you well since business often travels by word of mouth, as well as insurance listings (consistently poor results could get them dropped from a network).

And then there's the whole hippocratic oath, honor, and all that. A lot of docs might have big egos, but they're generally not evil people.

 

[a777pilot]

First, if you and your wife are 65 y/o or older, then your doctor should have given you both a pneumonia vaccine shot.

 

[Gooberlx2]

First, if you and your wife are 65 y/o or older, then your doctor should have given you both a pneumonia vaccine shot.

Assuming the OP and his wife get regular checkups in order to take such preventative measures.

 

[MotF Bane]

And then there's the whole hippocratic oath, honor, and all that. A lot of docs might have big egos, but they're generally not evil people.

This.

 

[rudder]

You do make in interesting point. In New jersey it is more common to see c-section births than other places accounting for 40% of births there. C-sections will get a larger payment from the insurance company. Doctors are also at less risk of a lawsuit. Now do the doctors in NJ actually believe that c-sections are better or are state legislators and hospital companies forcing NJ doctors to do push mothers toward c-sections.

 

[wuliheron]

I have no idea if this "pay your doctor when you are well" type of system would work out or not, there may be some complications to it, but it is just something I thought about because my wife has been fighting this cold/pneumonia thing for awhile.

In China that's still the system used by many people. Not only do you pay your doctor as long as they keep you well, but if you don't follow the doctors advice including lifestyle and dietary changes the doctor will drop you as a patient. Other primitive medicines use similar approaches and tend to be almost as effective with chronic care as modern medicine. However, if you get in a car accident or have a serious illness I'd definitely recommend the nearest emergency room.

Modern medicine is essentially assembly line crisis intervention oriented, but a few countries with socialized medicine have found some success with preventative medicine. In some cases it saves a great deal of money. There is even a new science known as "Integral Sciences" that attempts to combine more holistic traditional approaches with modern ones. You might look up "integral medicine" where you live to see if their are any practitioners in your area. However, most of these are all based on specific philosophies and it might help if actually share their philosophy. One study of shamanic medicine indicated that it was only really effective among people raised with those beliefs.

 

[brainhulk]

yeah, what you are referring to is fee for service. It undoubtedly is the cause of abuse by healthcare professionals. Thats why things are moving to capitated costs in which insurances will pay only one lump sum to treat an illness. In the new healthcare bill, hospitals are given bonuses if they can get you out of faster and also penalized if you are readmitted in less than a month.

my wacky idea for this was actually to pay clinicians like lawyers, plumbers and mechanics. they only get paid when the job is done, lol

 

[vi edit]

Or you could just go the route that many hospitals have gone and just salary your physicians. But that's harder when many GP's are independent rather than part of a group.

EDIT: Private practice as a whole is going down...

http://www.nytimes.com/2010/03/26/health/policy/26docs.html

 

[HardcoreRobot]

the incentive is, if you feel you are not getting good service from your doctor, you can take your business and $ to another one.

of course if communist health care continues to take over, and doctors become effectively employees of the state, then that incentive will go away. actually, incentive to be a doctor in general will go away.

 

[JimW1949]

the incentive is, if you feel you are not getting good service from your doctor, you can take your business and $ to another one.

of course if communist health care continues to take over, and doctors become effectively employees of the state, then that incentive will go away. actually, incentive to be a doctor in general will go away.

Obviously, if the wife is dis-satisfied with her doctor she can go to another doctor. But even so, the same circumstances would apply with ANY doctor she goes to see. The more times she sees the doctor, the more money the doctor gets paid. Again, I am not saying doctors intentionally keep you in ill health longer than necessary just to get more money. I am just saying it is in the best financial interest of the doctor if you have to make more than one visit to the doctor's office.

I realize that if patients become dis-satisfied with their doctor, they may go elsewhere for medical help. But there is a problem with that. There are a great many people who are, more or less, locked into going to one doctor, or at least to one medical clinic, because of their medical insurance plan.

When the wife and I were both working, we had medical insurance thru our respective employers. We had to go to doctors/medical clinics who were part of the medical plans that we had. If we went outside of the medical plan coverage, we had to call the insurance company and get approval first. Even when we got approval first, the medical plan may or may not cover the whole amount. So yes, you are right, you can go to another doctor, but if you do you may or may not be covered, or maybe only partially covered.

What it all boils down to is, the medical system in this country is such that you really do not have anywhere near as many choices as you think you have. A lot of people seem to think they can go to any medical clinic they want and have whatever they want done. I suppose if they have enough money, that is no doubt true. But for most of us, we are more or less, at the mercy of the insurance carrier to tell us which medical clinics we can go to and in some cases, which doctors we can see.

 

[CrazyAznDriver]

Or you could just go the route that many hospitals have gone and just salary your physicians. But that's harder when many GP's are independent rather than part of a group.

EDIT: Private practice as a whole is going down...

http://www.nytimes.com/2010/03/26/health/policy/26docs.html

This is what my wife does. She gets her salary from the hospital no matter how many patients she sees. She does get bonuses for certain things though. I'd think most doctors want to see their patients get better as soon as possible, no matter how they are paid.

 

[Mark R]

There are 'payment by results' systems which are in use in some places. These pay the doctor/clinic/hospital according to a set of rules which penalise them if they get it wrong.

E.g. in the UK, a hospital is paid according to the diagnosis for each patient seen. So if someone goes to the hospital with "medium severity pneumonia", then the governemnt will pay the hospital the national standard fee for "medium severity pneumonia" - this is a flat fee (which includes all expected tests, drugs, hospital stay, etc.) If the hospital give the wrong antibiotics, which don't help, and the patient stays for an extra 3 days. The fee is the same - the hospital cannot bill for the extra days, extra drugs, etc.

If the hospital get the diagnosis completely wrong - e.g. they diagnose pneumonia, it seems to get better, the patient goes home, and comes back where tests show that it is actually lung cancer. The government will claw back the 'pneumonia' bill.

In the UK this has been further refined. If the hospital's gives a patient 'optimal' treatment - there are certain rules about what is considered 'optimal' treatment, but it depends on timing, type of treatment, etc. - then the hospital can bill for an 'optimal' treatment bonus.

The doctors/nurses, etc. are paid a fixed salary, no matter how many people they see. However, because the hospital can only bill for correct diagnoses, and can only bill for bonuses if the doctors nurses do everything absoultely by the book, the hospital managers regularly check that doctors/nurses are doing the right thing. If they aren't, then the managers will chew them out/fire them.

 

[gevorg]

Hi there! So you're having a common cold? That is pretty normal actually, just go home and relax. You're very healthy, there is nothing to treat. By the way, thanks for paying your bills on time!

 

[moshquerade]

Never even crossed my mind that a doctor wouldn't try to get you well as fast as possible with all the knowledge, testing, and medications he/she can muster, because that is what they typically do.

 

[Blackjack200]

No offense OP, but are you just realizing this now? This is problem with any service industry. My used to work for my dad and his brother in their contracting business. When they got their truck back from the shop they'd joke around wondering what they broke for next time. It's actually less of a problem with heathcare (though it is still a problem) because there is so much demand anyway, and because you can sue the piss out of your doctor if he does one wrong thing.

But the upshot is that you need to be really invested in your own care.

Never even crossed my mind that a doctor wouldn't try to get you well as fast as possible with all the knowledge, testing, and medications he/she can muster, because that is what they typically do.

Oh please, I always know when my dentist wants to remodel his bathroom because the drill comes out. D:

 

[TheVrolok]

No offense OP, but are you just realizing this now? This is problem with any service industry. My used to work for my dad and his brother in their contracting business. When they got their truck back from the shop they'd joke around wondering what they broke for next time. It's actually less of a problem with heathcare (though it is still a problem) because there is so much demand anyway, and because you can sue the piss out of your doctor if he does one wrong thing.

But the upshot is that you need to be really invested in your own care.



Oh please, I always know when my dentist wants to remodel his bathroom because the drill comes out. D:

The problem is that healthcare is very unlike other service industries in many, many ways. Comparing breaking a truck on purpose (even as a joke) to get repeat business to the practice of medicine, is frankly laughable.

As for the OP, actually, I don't have enough time for that, but the main points have been hit by a few of the medically related posters.

 

[edro]

I think it works in the opposite way.

I know many people, myself included, who do not even go to the doctor unless it is very serious, because we have been screwed numerous times.
The doctor usually says "take time off", "take it easy", "here are some antibiotics", etc.

Our bodies do a better job fixing themselves than doctors can on most small ailments.

 

[Blackjack200]

The problem is that healthcare is very unlike other service industries in many, many ways. Comparing breaking a truck on purpose (even as a joke) to get repeat business to the practice of medicine, is frankly laughable.

As for the OP, actually, I don't have enough time for that, but the main points have been hit by a few of the medically related posters.

You think medicine is somehow special? lol. No, it's not.

 

[SlowSpyder]

If I see my doctor for an issue, and whatever she suggests or prescribes doesn't help, I'll call her office and she'll have a nurse call me to help, she'll call in a different prescription, or some other arrangement will typically be made. I don't think I've ever had to see my doctor multiple times for any one issue (other than my chronic bad back).

Also, I imagine insurance companies will start to get suspicious when they notice one doctor seems to see the patients they cover multiple times over and over again. Also, I think insurance companies negotiate terms with doctors... so a doctor cannot charge $5,000 for a checkup, or likely cannot claim that a patient had to be seen six times in two weeks for a cold.

 

[MastaTam]

You think medicine is somehow special? lol. No, it's not.

You don't think it's different? How many times have you heard of people suing their mechanics because their cars weren't properly fixed?

 

[ShawnD1]

And then there's the whole hippocratic oath, honor, and all that. A lot of docs might have big egos, but they're generally not evil people.

Repeat after me.
"if it doesn't get better on its own, book another appointment"

I swear every single doctor pulls that just so they can bill you without actually doing anything. You could have obvious signs of the plague and they would tell you to come back in a week.

 

[Hayabusa Rider]

My used to work for my dad and his brother in their contracting business. When they got their truck back from the shop they'd joke around wondering what they broke for next time.

You think medicine is somehow special? lol. No, it's not.

Strangely enough I've worked in contracting services and in health care. No one is reviewing crooked contractors, but physicians have everything they bill for on record. Theoretically everyone can be like your family, but if they were in medicine they'd eventually be caught.

The real problem is some practices bill for services not rendered or in some cases improperly billing. Speaking of the latter, regulations often prevent giving a needed service. It's been known to happen that a doc will use different codes to get the patient treated, but that too is happening less and less.