Thursday, September 24, 2009

The villian is fee for service-of that we can all agree?

Health care costs too much and it will cost more and we are told that a major cause of this is the fee for service system (apparently obesity is the other cause) that rewards volume and not quality.So to bend the cost curve ( I presume they mean bend it downward),we must do away with physician fee for service and pay for quality. Quality is nebulous and floating and if Congress has its way the definition will be whatever the secretary of HHS says it.

What does this really mean?

I think Dr. Wes nails it cleanly here when he says"

"Perhaps I'm too cynical, but I think the subliminal message coming from Washington so far is really this: doctors should be happy becoming salaried employees of larger health systems. This way, the government can pay the health system a bundled fee and the doctors can fight for their share of the kitty."

The larger health care systems, the vertically integrated systems, that some allege will save us from the old-fashioned and very harmful fee for service is a topic that I spent some effort ranting about two years ago.
see here. Not only will it save money but it will further the ubergoal of social justice. Those systems offer a chance to employ the utilitarian ethics to the cost curve bending exercise.

No comments: