2 ms·

> Why not go to the "other, other obvious" solution, which is results-based payments? There is a story about doctors in ancient China who are paid by their cli

> Why not go to the "other, other obvious" solution, which is results-based payments? There is a story about doctors in ancient China who are paid by their clients only so long as the client is healthy. When they fall sick, the doctor is not paid again until the patient is healthy again. Then the goal is not a cure for a disease but the prevention of disease. I don't know if any such thing ever really happened but it seems like it might be worth exploring even if only to illuminate the various possibilities.

ryanmcbride 5y ago
It's an interesting idea but the pessimist in me just sees this as incentivizing under-diagnosing, running fewer tests, etc.
- recursive 5y ago
  Running fewer tests is not necessarily bad, especially if your baseline is a system where the system is paid per-test.
- rileymat2 5y ago
  Also they have no interest in treating elderly (or anyone all that ill) if it requires any effort at all, as future healthy payments will not cover the expense. It is easy to see an optimal strategy of never treating anything.
- brezelgoring 5y ago
  Well the other option, which is to pay when a problem is found, can lead to over-diagnosis and finding issues where there are none. Its 'taking your car to an unknown mechanic' problem, he _will_ find a problem, and that is a problem too.
- foolinaround 5y ago
  what if the diagnosing and treatment were done by different doctors?
themacguffinman 5y ago
I think this only works if there's a scarcity of patients but it's rarely true that patients are rare. This will probably suffer from the real estate agent problem: in theory, real estate agents are incentivized to get you the best price because they get a cut for their efforts, but in practice it's more lucrative for them to flip more houses than put in the extra effort into your case. Likewise, I suspect doctors will find it easier & cheaper to not care about you and just move onto taking in other healthy patients.

ryanmcbride 5y ago

It's an interesting idea but the pessimist in me just sees this as incentivizing under-diagnosing, running fewer tests, etc.

recursive 5y ago
Running fewer tests is not necessarily bad, especially if your baseline is a system where the system is paid per-test.
rileymat2 5y ago
Also they have no interest in treating elderly (or anyone all that ill) if it requires any effort at all, as future healthy payments will not cover the expense. It is easy to see an optimal strategy of never treating anything.
brezelgoring 5y ago
Well the other option, which is to pay when a problem is found, can lead to over-diagnosis and finding issues where there are none. Its 'taking your car to an unknown mechanic' problem, he _will_ find a problem, and that is a problem too.
foolinaround 5y ago
what if the diagnosing and treatment were done by different doctors?

themacguffinman 5y ago

I think this only works if there's a scarcity of patients but it's rarely true that patients are rare. This will probably suffer from the real estate agent problem: in theory, real estate agents are incentivized to get you the best price because they get a cut for their efforts, but in practice it's more lucrative for them to flip more houses than put in the extra effort into your case. Likewise, I suspect doctors will find it easier & cheaper to not care about you and just move onto taking in other healthy patients.