4 ms·

And that's partly my point. Does the doctor want to kill you? No, he or she wants to heal you and be paid well. Does the claims analyst at the insurance compa

by ethbro 8y ago

And that's partly my point. Does the doctor want to kill you? No, he or she wants to heal you and be paid well. Does the claims analyst at the insurance company want customers to die? No, he or she wants to pay as little as possible while keeping you healthy. And yet when both of these players are placed in the system we've constructed, the strictly dominating, logical strategies for both are sociopathic. And so they adjust their behavior in that direction. I'm hopeful that pushing outcome-driven analytics onto the medical field will drive a lot of productive change. The whole reason we abstracted care choices from payment is that we couldn't answer the question, "How much is this procedure / test / consult worth to you?" And without that, we're waving our hands in the air as to whether or not it makes sense to skip an MRI scan.

dredmorbius 8y ago
Bad assumption: "Indiana cardiologists sued for alleged unnecessary surgeries" (October 28, 2014) MUNSTER, Ind. (WLS) -- Dozens of people are joining a lawsuit filed against three Northwest Indiana cardiologists as well as Munster Community Hospital for allegedly performing unnecessary procedures. After two patients announced legal action six months ago, dozens more have come forward accusing three Indiana doctors of medical malpractice and, in some cases, wrongful death. Lawyers say their investigation has revealed that 75 percent of heart procedures were performed unnecessarily.... http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/ http://abc7chicago.com/health/indiana-cardiologists-sued-for... More: https://scholar.google.com/scholar?q=unnecessary%20surgery&btnG=Search&as_sdt=800000000001&as_sdtp=on https://scholar.google.com/scholar?q=unnecessary%20surgery&b... (550,000 results) https://duckduckgo.com/?q="unnecessary+surgery"+fraud https://duckduckgo.com/?q="unnecessary+surgery"+fraud
- ethbro 8y ago
  The example does not disprove the point. Somewhere around 50M surgeries / year. Some of those are going to be bad. If you want to talk about defensive medicine and financial and legal malincentives that pressure doctors into anti-patient choices, I'm all ears. Freakonomics had a great mini-series on that. But pointing to horrific botched or fraudulent surgeries and acting outraged? Meh. I accepted some humans were immoral a long time ago. If it's most surgeons or many surgeons, or they aren't getting sued and/or charged with malpractice, then it's an issue. Otherwise, I leave it to the local nightly news.
  - dredmorbius 8y ago
    The extreme cases both refute your blanket allegations of fundamental goodwill and strongly suggest there might be a substantially larger set of less-nefarrious and malevolent, but still corrupt practices: Insurance and workers comp fraud, overprescriptions, unnecessary labs and imaging, pharma kickbacks, the opioids crisis and Perdue pharma specifically, device and equipment practices, and far, farr, far more. The fundamental problem is that in the US, most providers are paid to render services, drugs, and equipment, but not for making or keeping patients and populations healthy. Payors (insurance companies and administrators) are similaly incentivised on profits, not outcomes.
    - ethbro 8y ago
      There are three possibilities. 1) Extreme cases are pervasive 2) Extreme cases occur but are rare 3) Extreme cases never happen Aside from the absurdity of abusing statistically-defined adjectives, I'll assume you know what I mean. The health care industry is BIG. Things happen a lot, even if they're only 0.01% of the time. I haven't seen any proof that indicate (1) is true, previous shock post included. And if it's not, it's not the most important problem to focus on. In contrast to, say, the incentives you note.
      - wu-ikkyu 8y ago
        The perverse incentives are what create the extreme cases. It's plainly obvious that the US healthcare system as a whole is an extreme case when compared to the rest of the world.
ionised 8y ago
> No, he or she wants to heal you and be paid well. That first part isn't guaranteed in a for-profit system.

by ethbro 8y ago

dredmorbius 8y ago

Bad assumption: "Indiana cardiologists sued for alleged unnecessary surgeries" (October 28, 2014) MUNSTER, Ind. (WLS) -- Dozens of people are joining a lawsuit filed against three Northwest Indiana cardiologists as well as Munster Community Hospital for allegedly performing unnecessary procedures. After two patients announced legal action six months ago, dozens more have come forward accusing three Indiana doctors of medical malpractice and, in some cases, wrongful death. Lawyers say their investigation has revealed that 75 percent of heart procedures were performed unnecessarily.... http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/ http://abc7chicago.com/health/indiana-cardiologists-sued-for... More: https://scholar.google.com/scholar?q=unnecessary%20surgery&btnG=Search&as_sdt=800000000001&as_sdtp=on https://scholar.google.com/scholar?q=unnecessary%20surgery&b... (550,000 results) https://duckduckgo.com/?q="unnecessary+surgery"+fraud https://duckduckgo.com/?q="unnecessary+surgery"+fraud

ethbro 8y ago
The example does not disprove the point. Somewhere around 50M surgeries / year. Some of those are going to be bad. If you want to talk about defensive medicine and financial and legal malincentives that pressure doctors into anti-patient choices, I'm all ears. Freakonomics had a great mini-series on that. But pointing to horrific botched or fraudulent surgeries and acting outraged? Meh. I accepted some humans were immoral a long time ago. If it's most surgeons or many surgeons, or they aren't getting sued and/or charged with malpractice, then it's an issue. Otherwise, I leave it to the local nightly news.
- dredmorbius 8y ago
  The extreme cases both refute your blanket allegations of fundamental goodwill and strongly suggest there might be a substantially larger set of less-nefarrious and malevolent, but still corrupt practices: Insurance and workers comp fraud, overprescriptions, unnecessary labs and imaging, pharma kickbacks, the opioids crisis and Perdue pharma specifically, device and equipment practices, and far, farr, far more. The fundamental problem is that in the US, most providers are paid to render services, drugs, and equipment, but not for making or keeping patients and populations healthy. Payors (insurance companies and administrators) are similaly incentivised on profits, not outcomes.
  - ethbro 8y ago
    There are three possibilities. 1) Extreme cases are pervasive 2) Extreme cases occur but are rare 3) Extreme cases never happen Aside from the absurdity of abusing statistically-defined adjectives, I'll assume you know what I mean. The health care industry is BIG. Things happen a lot, even if they're only 0.01% of the time. I haven't seen any proof that indicate (1) is true, previous shock post included. And if it's not, it's not the most important problem to focus on. In contrast to, say, the incentives you note.
    - wu-ikkyu 8y ago
      The perverse incentives are what create the extreme cases. It's plainly obvious that the US healthcare system as a whole is an extreme case when compared to the rest of the world.

ionised 8y ago

> No, he or she wants to heal you and be paid well. That first part isn't guaranteed in a for-profit system.