What Do We Pay Doctors to Do?
Challenging many widely held assumptions about health care, Arnold Kling argues that doctors should be paid - not for their results, not for their efforts, and not per patient - but rather for their adhering to prescribed treatment guidelines.
According to Kling, there are four possible methods to pay doctors:
- Capitation -- pay a fixed amount per year per patient
- Outcome -- pay on the basis of the health of patients
- Effort -- pay on the basis of labor and capital costs of providing services
- Process -- pay on the basis of adherence to guidelines
Kling argues that capitation creates the medical rationing that recently caused the Canadian Supreme Court to strike down provisions of the Quebec medical system
. Paying doctors on outcomes will not work because too many factors are beyond their control, he adds.
Rewarding on effort is the current American system, which he characterizes as "activist medicine" in another article
. Activist medicine is the tendency to pour greater and greater amounts of effort into medical treatment in return for questionable added medical benefits.
This activist approach, he argues, is what makes the American healthcare system so expensive.
He concludes that paying on guidelines should therefore be considered. Some outside expert board should establish treatments for illnesses which doctors should follow.
Of course, it would be no small trick to set up uniform medical guidelines. Nor would it be easy to change them, once they were put in place. Look at how difficult it has been to change America to the metric system of measurement. Imagine some effort to establish a rational system of English spelling. Try, just try, to simplify the tax code. Similar problems would plague any effort to modify uniform medical standards.
Still, Kling is a clear, original thinker and a good writer. He should be read by anyone wanting to increase his understanding of how and why the American medical system is the way it now is.