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The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not. Well above what they would earn e
by kuiper0x2 5y ago
The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not. Well above what they would earn elsewhere.
Their incentive then becomes to keep a good relationship with you so you continue to pay them. The best way to do that is to keep you healthy and happy.
- zz865 5y agoOr even better pay nothing and get a government run system that is smart enough to figure out what is important and what is wasteful.
- lupire 5y agoThats a wish, not a plan. Medicare just committed to spend $250 per person (not per patient) per year on an ineffective Alzheimers drug.... https://arstechnica.com/science/2021/11/dubious-56000-alzheimers-drug-spurs-largest-medicare-price-hike-ever/ https://arstechnica.com/science/2021/11/dubious-56000-alzhei...
- thayne 5y agothey also have an incentive to keep you alive as long as possible since they don't get paid if you die.
- sokoloff 5y agoHaving witnessed the terminal stages of several family members, additional days of being undead is not necessarily desirable for the patient.
- khafra 5y agoFor specifically the doctor version of the principle-agent problem, Robin Hanson published an incentive-compatible solution over 25 years ago: http://mason.gmu.edu/~rhanson/buyhealth.html http://mason.gmu.edu/~rhanson/buyhealth.html
- shonenknifefan1 5y ago> To cure health care, give your care-givers a clear incentive to keep you well. Make sure that when you lose, they lose, and just as much. Buy lots of life and disability insurance from your care-givers, and have a third party, unable to act against your life or health, pay you to be the beneficiary.
- lupire 5y agoWhich doctor is selling disability insurance?
- mattnewton 5y agoSo, basically bundling insurance with the healthcare provider, like kaiser?
- khafra 5y agoThe quantitative difference is big enough to be qualitative. You have to buy a lot of life insurance, more than people normally get, to make it work. The disinterested third party beneficiary makes this affordable: > There are, however, two big problems with this approach. The first is that even though my life may be worth $10 million to me, most of the (huge) insurance premium to pay for this insurance would be wasted from my point of view -- there probably is not one person to whom I would want to give this much money when I die. The other problem is moral hazard -- heavy insurance may reduce my incentive to keep myself healthy, and may even create incentives for my relatives to try and hurt me. It might be a problem if I could only give my doctor a 50 percent interest in my life by taking away 50 percent of my own interest, or by giving a minus 50 percent interest to my relatives.
- gwerbret 5y agoI agree with the idea of paying the doctor a flat fee every month, but in my variant, the doctor has to repay you the entire sum you've paid to date, with 10% interest, if you succumb to any preventable illnesses; in other words, the doctor now has some real skin in the game. S/he becomes motivated not only to keep you well, but to keep the fees reasonable.
- dstroot 5y agoThe doctor will purchase "refund insurance" and pass that cost along in the monthly retainer.
- gruez 5y agoYeah that just passes the buck to someone else (the insurer), who is incentivized to investigate malfeasance.
- gwerbret 5y agoFair point, but if the client does develop a preventable condition, it would be easy to show this is due to dereliction/negligence on the part of the physician, so the insurance would not pay out. If the client came down with a condition and the physician was not negligent, the condition would likely be non-preventable, wherein the refund clause wouldn't apply, anyway. Thus, regardless of outcome, insurance can never pay out, and the physician retains all the liability, i.e. no use for insurance.
- pc86 5y agoHow is it "easy" to show negligence?
- catlikesshrimp 5y agoSome insurance policies must not exist. Malpractice policies must not exist. I am sure if I asked my mates they would all disagree with me on this. Bad luck for the patients.
- asimops 5y agoThis was also my first idea when I read the problem. As the payments stop as soon as you die, this is a strong incentive. The only thing I could think of arguing is, that the doc could keep demanding more and more. But that would imply a situation with only one or very few skilled individuals, right?
- cfu28 5y agoThis assumes that actions that make a patient happy also make them healthy. There’s a risk that pursuing patient happiness can come at the expense of patient health. The doctor may be more inclined to keep a patient from switching doctors to keep getting paid.
- jtbayly 5y agoSuch as doctors that prescribe sleeping meds to rich clients that... end up dead.
- catlikesshrimp 5y agoPay a fixed rate.... Like a health insurance plan? That doesn't work well in the US Edit: The smarter person will charge you while you are healthy and not treat you when you need it, or underdeliver for the expectations.
- mattficke 5y agoThis is basically the Kaiser model. Kaiser's doctors are salaried, rather than getting paid per procedure. Works pretty well! (I think the actual answer to the question in the OP is, at least in part, to license more doctors. Then the cartel doesn't have as much pricing power and medical care is less of a luxury good. The rich person should really hire a lobbyist.)
- infecto 5y agoI had Kaiser for a year and I actually enjoyed it. I saw a couple specialist but I never had any major work done so perhaps I am biased. It is funny to say it since I believe Kaiser originally was one of the opponents of a single payer system but using Kaiser kind of felt like what a government health care system should be. Very low friction. Oh I need blood work or whatever done, walk down the hall. Everything felt more convenient.
- hellbannedguy 5y agoIt is so much better than driving office to office while not feeling well. Dealing with ego. Dealing with huge bills even when having good insurance. I sometimes hear people talk about doctors like they are going to cure you when you need them. The older I get, the more I see the profession as an art. I remember Lance Armstrong commenting on his cancer treatment. He basically said he knew he had the best medical care because of his wealth. He said driving from doctor to doctor was just depressing/agonizing, and he felt it was unnessary.
- spaetzleesser 5y agoSame here. I enjoyed knowing there is one place where I can go and have everything done. They also sent reminders about vaccinations and checkups. I have moved away from CA so I don't have Kaiser anymore. I generally rarely go to a doctor and if I ever get sick I don't even know where to go :-(
- lotsofpulp 5y agoThe golden days of the doctor “cartel” (and people in the healthcare chain in general) are over. https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physicians-in-2022-practice-costs-on-the-rise.html https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physic... The 80s/90s/00s were probably the golden years for them, but they got in the political spotlight, and combined with the decreasing proportion of young to old people, the government is going to push down cuts to whoever lacks political power to push back. Such as smaller businesses like independent doctor offices and pharmacies. The government has already increased supply by letting Nurse Practitioners and Physician Assistants do stuff that doctors used to do, and I suspect a lot more price discrimination is on the way. Expect the average quality of care to fall (may not be a bad thing if overqualified people were treating pink eye), and paying more will result in being seen by someone more qualified.
- efsavage 5y agoIf we're trying to handle the case of greedy doctors, why would a doctor accept a very sick patient who is going to require a higher-than average amount of care and probably not live (i.e. pay) as long? If they can't pick their patients, how do you protect the unlucky ones who end up with too many very sick patients?
- michaelrpeskin 5y agoThat's what I do. It's called "direct primary care". In the last 10 years, I've used two DPC doctors. I loved my first doctor because we had the same philosophies towards health. Last year she started drifting too "mainstream" and I didn't like her style, so I switched and took my money elsewhere. I found a new guy who is really aligned with me and it's been great. It's almost as if having choice and market can work :) I get the super high-deductible catastrophic with HSA plan from my work, and then I pay $135/mo for my whole family for the DPC doctor (I could pay that $135 with my HSA and have it be on pretax money, but I'd rather invest my HSA pretax right now). The total there is less than any other insurance available to me. If I ever need anything, I just call or email my doc, most of the time we just do a (secure) video chat and I'm done and I don't need to make a trip in. If it is more severe, I can easily get a same-day appointment. He knows me, knows my history, and has an incentive to keep me healthy. The healthier I am, the more I pay him and don't see him. I love the model!
- lotsofpulp 5y agoI pay $25 to $30 per hour to housekeepers. I question the sanity of a doctor charging $135 per month for multiple people.
- ivalm 5y agoTypical panel size is ~1200 patients. So to get $300k/year that’s $20.8/person/month.
- deleted 5y ago[deleted]
- lotsofpulp 5y agoThat’s a good point. I’ll have to ask some friends about overhead. Seems like a weirdly small number though compared to insurance premiums + deductibles, and what doctors usually get per visit when we go for run of the mill fevers for the kids (~$150+ each time).
- 5y ago
- winternett 5y ago>The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not. Easy fix... "Just be wealthy!" lol... :| I've paid for the absolute best insurance I could find this year and gone to doctors my entire life that simply don't care. I've had everything from colonoscopies to MRIs done and I haven't spent more than one day in my entire life in a hospital overnight in over 40 years. Many would say I'm pretty healthy, but who knows? It usually seems like doctors peddle as much fear as web MD now in order to drive me through the service bay of fees every time I have an ache or troublesome pain. If it's any consolation though, my dentist, my auto maintenance shop, my lawyer, and even my local supermarket want a constant revenue stream out of me because they have a pipeline of service that they know they can get a customer hooked on if they coordinate their efforts and make their pricing variable based on being properly opportunistic. A lot of the tactics the health care industry regularly uses to sell services (and drugs of course too) are from the nefarious book of street drug dealers... In a bad economy, the scams and opportunism are ripe. Getting a second opinion is often VERY EXPENSIVE as well. Be careful my friends, sometimes it's better to face your fears of "WebMD prescribed" death head-on rather than to bankrupt yourself, because if you don't die, living broke or in extreme debt can be a "silent killer" and harmful mentally and physically to you too. Maybe marry a doctor... That might cut extreme health care costs... By about 5% if you're lucky... :P
- kiliantics 5y ago> Easy fix... "Just be wealthy!" lol... :| Or have all doctors employed by the state on good fixed pay
- d0gsg0w00f 5y agoI think the premise of the article is that this is _more_ of a problem when you're wealthy and you want to be "as healthy as possible". If you're poor you're only going to pay the bare minimum to stay alive so capitalism takes over.
- pessimizer 5y agoYeah, I don't get it. If you have infinite resources, and you absolutely know the doctor is competent (a question omitted here that would make this more interesting) just tie the doctor's fate to yours. I don't know if overpaying will work, because the marginal value of money goes down the more you have. Once your doctor is rich enough, he won't be overly concerned if you die and the checks stop coming in. The real answer is the action-movie/not-that-uncommon-in-reality answer: Credibly promise to shoot the doctor if you die, or to shoot the doctor's family members.
- wayoutthere 5y agoI do this! I’ve found that my employer-provided health insurance is less than worthless for routine health care. I actually pay less by going to providers who don’t accept insurance — even though I maintain bare-minimum coverage and an HSA. I don’t think I used my health insurance at all this year — at least not enough to come close to meeting the deductible. My primary care doctor uses this model — I pay $300/yr for basically unlimited access. I have a therapist who I pay $75 a session. I use GoodRX for prescriptions and get better prices than the post-deductible price on my insurance plan. Basically, I pay less out of pocket by not using my insurance. I also get to choose my doctors, and they treat me as an actual patient rather than a number. Health insurance in the US is a scam.
- lupire 5y agoThar only wokrs because you don't need substantial healthcare. Like driving a car wothout insurance and not getting crashed.
- colinmhayes 5y agoThis type of insurance is called capitated, seeing extensive use by medicare and Kaiser Permanente.
- andrelaszlo 5y agoI had the same thought, but I can think of two problems with it. 1. The doctor's stake is pretty limited. The old royal court doctor model is the perfect model for this. It's based on the doctor having very few (one?) patient. If the patient dies, not only do you risk your substantial income and high status, but you might even lose your life if the royal family gets suspicious enough. It's a good solution if you're very rich. Much richer than the average doctor. 2. When you have more than one patient, at some point you probably earn more by treating less. The less work you spend on each patient, the more patients you can take on. The more patients you can take on, the more you earn. If you simply stop treating patients - "you're perfectly healthy, don't worry" - you can basically take on an unlimited amount of patients and collect their fees until they perish. (This sounds like a caricature of the US insurance system, from my western EU perspective.) --- What about this convoluted system: - The doctors get paid a recurring fee that starts small and increases the longer you keep a patient around. This counters the problem that patients can just be replaced by a younger and healthier patient. - The doctors get assigned patients randomly. This addresses the problem that doctors would choose young and healthy patients. - The doctors can only have a certain number of patients at once. This makes each patient more valuable, and the doctor will be incentivized to actually treat patients, instead of having as many as possible. Oh wait... Now, the problem is that a young, ambitious, greedy doctor would be incentivized to cull their set of patients and select for the most viable ones in the long run. This actually incentivizes them to kill off patients with minor defects?
- thebean11 5y agoThat incentivizes doctors to avoid taking on sick patients, as the work/reward ratio is much higher.
- jrm4 5y agoRight? I can't get over the "meta" point here of what we're here doing: This is not a conceptually difficult problem to fix and a whole lot of countries besides the one I live in have solved it quite easily, but here we are having to contend with it. It's just quite frustrating.
- bshep 5y agoThis reminds me of something I think i heard ( or something similar ) in a movie : “I’m not going to kill you, but you would surprised how much suffering you can live through.”
- deleted 5y ago[deleted]
- apyrros 5y agoActually, we are increasingly doing that already in the US. Value-based healthcare, aka Medicare Advantage uses something called risk adjustment. Payments are based on patient demographics and select disease categories (HCC codes) with bundled payments. The intent is to slowly get rid of fee-for-service healthcare.