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Patient-perceived quality of care isn't the right measure. Patients don't like being told that they need to exercise, lose weight, drink less alcohol, rest. A

Patient-perceived quality of care isn't the right measure. Patients don't like being told that they need to exercise, lose weight, drink less alcohol, rest. A large part of a patient-perceived score is whether they get what they want. This often isn't in the best interest of the patient. With patient-score focused medicine, you get over-prescription of pain-meds, adderall, antibiotics. You also incentivize doctors not to challenge patients with dangerous views like anti-vax.

eldavido 8y ago
That's perhaps true in some cases. But I think patients need to have a little more skin in the game. Take knee surgery. My surgeon friend does 7 of these each day at $30K/surgery (he "only" gets about 10% of the charged amount). If there was even a 10% copay on this, possibly means-tested if you want to make it fair for poor people (meaning it goes up the more income/wealth you have), you'd better believe more people would choose dietetics (my mom's profession, group classes cost like $10 each) over $30K knee replacements. You're talking about a procedure that costs roughly the yearly pretax median income of a US adult. Some people have multiple of these per life. We can play the "who pays" game all day, pushing the cost of care around on the plate, as it were, but until we stop prescribing high-cost surgeries and expensive solutions to chronic conditions, the needle isn't going to move on how much we spend on health. 20% of GDP and growing, to be exact. I just don't think there's a way around this without forcing patients to feel a bit more pain.