The Washington Post had an article that covered how hospital profits are increased when there are complications with surgery. I do not think that the health care system causes complications intentionally, but for me this links back to arguments made by Lawerence Lessig.
His argument in his book “Republic Lost” is that the presence of money (profits), in the wrong location (complications related to surgery) causes us to think differently about the relationship between those that provide care and patients (givers and receivers). He believes that the mere presence of money causes us to change our trust relationship with other party.
There does seem to be some evidence of physician-led abuses in the care community. But abusers are more than just providers. An entire ecosystem of characters are at work trying to get a slice of what is an overwhelmingly large slice of money in the US economy.
It is a large pie and so we should expect to have some abuses by all parties involved–including patients! The issue is really about how the presence of money and of stories that discuss it like the above, distorts our trust relationship. According to Lessig, it is this distortion that is decreasing our trust relationship.
Using Lessig’s argument, it is not that we think Providers are needlessly causing complications to obtain more profit, but the presence of money for the wrong incentive causes us to think twice. This is the essence of his argument of “dependency corruption.”
To remove these incentives and restore trust–is the solution an integrated capitated model like Kaiser Permanente? Where Provider & Payer are one and the same and hence, there is a motivation to reduce costs and improve outcomes because those who save dollars get to “cash the check?”
If you believe that this incentive model is the only one that could restore trust, what is the eventual outcome? Could it be that the entire healthcare insurance market will fragment into thousands of small plans perhaps like Canada where there is a central payer and then thousands of healthcare plans to fill in the cracks?
Or is the only way to restore trust to go to a national payer system so that a majority of the healthcare delivered would have an integrated incentive?
Are there any in-between models that work?
Its not clear what will happen but it does seem that trust, as abstract as it sounds, could lead to major structural shifts in the industry just as trust in today’s government seems to be greatly diminished (citizens think that the government is captive to special interest groups and lobbyists who finance their campaigns).
Regardless, I think that smart information management technologies can support that type of fragmentation and still be efficient so we should not let technology limit the best model for healthcare delivery. After all, the new health care law (patient protection act) is attempting to create a nationwide individual market (almost overnight) and the plans must meet minimum standards. They will also include little gap-fillers to fill in the gaps for those that want delta coverage.
We’ll see.