Monday, November 26, 2007

Still more reasons to throw out P4P

The following is a quote appearing in DB MEDICAL RANTs, in turn taken from a recent BMJ article about the P4P misadventure in England, complete with words spelled in British English.

The whole initiative is based on reductive linear reasoning that views the body as a machine and assumes that a standardised treatment will produce an equally standard unit of beneficial outcome. However, any practising clinician knows that the same treatment applied to two people with the same diagnosis can produce very different outcomes. Complexity theory suggests that the body is more usefully regarded as a complex adaptive system, characterised by rich interactions between multiple components that produce unpredictable outcomes. This analogy makes much more sense of clinical experience. Psychological states and social contexts exert measurable effects on the functioning of the body. Standardised treatments ignore all of this.



The purveyors and apologists of P4P will not, for the most part, be convinced either by cogent arguments or empirical data showing the harm in such programs.They are not about doing good or really promoting "quality" -in the good care sense of the word- They are about control and the purpose of controls is to spend less money and/or make more money or as Dr. Fogoros puts it, it is about covert rationing.

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