4 ms·
"less gameable policy" -> clinics do not get a blank check, for good or bad, they have to comply with government's bureaucracy requirements, i.e., explicitly ta
by ggrrhh_ta 6y ago
"less gameable policy" -> clinics do not get a blank check, for good or bad, they have to comply with government's bureaucracy requirements, i.e., explicitly take action that attests that the clinic considers the procedure to be necessary and covered under that particular government aid. That is, if the clinic does the bureaucratic 'work' when the procedure would not have been recommended otherwise, their actions border: fraud and healthcare crime.
"The clinics had the incentive to “fix teeth for people in need” - so they did", in the case at hand, being the procedures unnecessary, the incentive was not "fix teeth for people in need", but "increase profits".
- mattcwilson 6y agoI agree completely that “increase profits” was a goal for the clinics, but I mean something a little different by incentive. I mean “a behavior that is being encouraged or rewarded by others.” You are asserting that the government’s policy was sufficiently specific regarding “medical necessity” that would clearly show these claims would not qualify. If that were the case, then the government itself should not have paid out those claims in the first place. The fact that they did pay the claims (at least until someone blew a whistle) suggests either that their policy was vague enough to not be so enforceable, or that their review and enforcement was lax (or both). That’s my point - if the policy and enforcement had been clear from the get go this wouldn’t have been so big a deal. One or two bad apples try something and get sanctioned and the whole thing stops being an incentive to bad actors. We agree that something changed in the situation such that this is no longer occurring, right? What was that change, and why was it not so in the first place?