Defend Private Healthcare

[Ivor the Engineer]

No flu vaccination is a great example, because it shows that you can deliver healthcare benefits by giving doctors financial incentives.

I can understand why you want to try and ignore that, but that does not make it a bad example.

Vaccination is a poor example because it generally does not address an individual need, but a public health initiative for a group. I.e. the objective is to persuade people to choose to be vaccinated. If it is know the medical professional giving them information on the benefits and risks of vaccination is being paid for every person they get to choose to be vaccinated, his/her advice is runs the risk of being discounted because of perceived bias.

 

[Jaggy Bunnet]

Vaccination is a poor example because it generally does not address an individual need, but a public health initiative for a group. I.e. the objective is to persuade people to choose to be vaccinated. If it is know the medical professional giving them information on the benefits and risks of vaccination is being paid for every person they get to choose to be vaccinated, his/her advice is runs the risk of being discounted because of perceived bias.

I seriously doubt that risk is higher than if the person giving them information is a paid employee of a government agency that is promoting the benefits of vaccination. Both have a perceived bias.

There are problems with incentives and piecework in the medical field (in particular I am aware of some horrific stories involving dentists). However there are problems with having no incentives as well - if a doctor can do no extra work and earn the same amount of cash, what is going to encourage him to commit effort, time and his own resources to deliver better results?

For example, the flu incentive might make it worth while for a GP to contact unvaccinated individuals rather than wait for them to show up at the surgery.

 

[Francesca R]

I'm not sure what you mean. Can you clarify?

GP businesses ARE private firms. They are typically run as partnerships where the doctors are the partners and entitled to the profits the business makes.

GP businesses have always had the choice of providing NHS services or not.

I don't think you mean what I do. The first such example dates from 2006

http://www.networks.nhs.uk/news.php?nid=800

 

[Jaggy Bunnet]

I don't think you mean what I do. The first such example dates from 2006

http://www.networks.nhs.uk/news.php?nid=800

We do appear to be talking at cross purposes.

What I mean is that your local GP surgery is (very probably) owned and operated by a partnership. The partners in that partnership are likely to be some or all of the doctors that operate out of the surgery. That partnership then has a contract with the local primary care trust to provide services - for which it is paid at agreed rates. The partnership pays its own costs and the difference between the two is profit, which is shared by the partners.

It is a private sector business.

 

[Francesca R]

I think I said the profit motive has no place in the provision of health care. I.e. the decision of how much medical treatment to provide (including no treatment at all) to a person in need should not be based on that person's ability to pay.

This is inconsistent with your previous statement. If you have to entice a person into being a physician with higher income, you are giving them a profit motive to provide a medical service, relative to doing something else, and effectively leaving putative patients to go whistle.

 

[Francesca R]

It is a private sector business.

Yes--regulated, reasonably smartly perhaps, or as smart as it is possible to do so under the doctrine of freely delivered essential medical service to all. Dismantle a few of those regs and there exists a potential for conflict between that doctrine and private supply of medical care. The conflict is not entirely absent now either. How could it be? It is not as if the interests of all parties are perfectly aligned.

 

[Ivor the Engineer]

This is inconsistent with your previous statement. If you have to entice a person into being a physician with higher income, you are giving them a profit motive to provide a medical service, relative to doing something else, and effectively leaving putative patients to go whistle.

It is not inconsistent at all. What you are talking about is the provision of medical professionals, not the provision of treatment by those medical professionals.

 

[Francesca R]

It is not inconsistent at all. What you are talking about is the provision of medical professionals, not the provision of treatment by those medical professionals.

Can't really see how you separate the two. It seems that you want to attract people to medicine with monetary incentives, but thereafter have no connection between their contribution to the profession and any monetary incentives. Right?

 

[Jaggy Bunnet]

Yes--regulated, reasonably smartly perhaps, or as smart as it is possible to do so under the doctrine of freely delivered essential medical service to all. Dismantle a few of those regs and there exists a potential for conflict between that doctrine and private supply of medical care. The conflict is not entirely absent now either. How could it be? It is not as if the interests of all parties are perfectly aligned.

Is there any evidence that the GP practice referred to in the link you posted will operate under a different regulatory environment? Apologies if this is in the link, I only skimmed it and didn't see anything.

BTW, my knowledge of GP practice structures is not completely current - it is entirely possible that since I dealt with them they may have changed their legal form to use limited companies or limited liability partnerships. However they are, and always have been, private sector businesses.

http://216.239.59.132/search?q=cach...ice+partnerships+NHS&hl=en&ct=clnk&cd=3&gl=uk

I don't understand what you mean by the doctrine of freely delivered essential medical service for all. As far as GP's are concerned, they do not do it for free, they do it for payment - that the payment comes from the NHS rather than direct from the patient does not make it free.

 

[Francesca R]

Is there any evidence that the GP practice referred to in the link you posted will operate under a different regulatory environment? Apologies if this is in the link, I only skimmed it and didn't see anything.

It's not about evidence so much as about incentives, to my mind. Evidence in the form of quite steep rises in GP salaries since the 2004 reform of the GP contract might qualify for what happens in the absence of effective control of state purse strings. But I imagine(d) from what you've written on this that your knowledge is greater than mine

I don't understand what you mean by the doctrine of freely delivered essential medical service for all. As far as GP's are concerned, they do not do it for free, they do it for payment - that the payment comes from the NHS rather than direct from the patient does not make it free.

I mean, this is public policy. No it is not GP policy I know. So you have partially--but not completely--aligned interests and partially--but not completely--opposing interests. I would say that this makes for a somewhat, but not completely, stable co-operative equilibrium.

 

[Ivor the Engineer]

Can't really see how you separate the two. It seems that you want to attract people to medicine with monetary incentives, but thereafter have no connection between their contribution to the profession and any monetary incentives. Right?

I want no connection between the provision (or not) of treatment to individual patients and monetary incentives. Further, I do not see how a physician refusing to treat those in need of medical attention because they cannot afford his/her fee is compatible with the principles of medical ethics.

There is a straightforward solution. Physicians accept their remuneration via a salary from a third party rather than fee for service.

 

[Francesca R]

I want no connection between the provision (or not) of treatment to individual patients and monetary incentives. Further, I do not see how a physician refusing to treat those in need of medical attention because they cannot afford his/her fee is compatible with the principles of medical ethics.

There is a straightforward solution. Physicians accept their remuneration via a salary from a third party rather than fee for service.

Then I think you substitute one moral hazard (the risk of a patient not being able to afford treatment and going without) for another (the risk of a physician not delivering beneficial treatment because they are paid the same regardless). I don't think that is a smart solution. I think the "hybrid" represented by the UK NHS is superior to both of those.

 

[luchog]

Right, so Americans are greedy and will screw each other over to make an extra dollar. Do you think this attitude may extend to those in the medical profession, or are physicians different to the typical American?

What makes you think it's just Americans? Do you truly believe that Canadians, British, Australians, Dutch, French, etc. wouldn't do the same thing if their system permitted it? If you believe that, then explain why Americans are so inherently different.

It's nothing to do with being Americans, it has to do with simple human nature, and a system with a huge, exploitable loophole.

And this is hardly limited to the medical industry. It affects every major industry in the country. It indicates a need for tort reform, not for socialism.

 

[gtc]

Medical treatment is either required or not required.

That isn't true at all. As an example, take a 90 year old person who is assessed to be at a significant risk of developing a fatal stroke. The treatment available would lead to severe side-effects that would drastically reduce their quality of life. Should the patient be given the treatment?

This is a real example, although I forget whether it was a stroke that was the danger, and it was the treatments that were prescribed for the side-effects of the treatment that were drastically reducing the quality of life.

As I said before, flu vaccination is a poor example because it can be argued it is not a medical need, rather a wanted risk reduction.

Arguably, all treatments are 'risk reduction'. From antibiotics to pills that reduce blood pressure.

Then I think you substitute one moral hazard (the risk of a patient not being able to afford treatment and going without) for another (the risk of a physician not delivering beneficial treatment because they are paid the same regardless). I don't think that is a smart solution. I think the "hybrid" represented by the UK NHS is superior to both of those.

That bears repeating. I also think it is wrong to presume that Doctors have to be shielded from the profit-motive lest they start turning patients away. It is presuming that no doctor would work 'pro-bono' or that they wouldn't feel ethically bound to help the needy.

I know lawyers, physio-therapists, occupational therapists, engineers and financial planners (all of whom work in profit-driven industries) who volunteer their time to help the needy.

 

[ConspiRaider]

Okay troops, quiet down. Quiet down I said! Got an announcement to make so... SHUT UP, EVERYONE! All right, now as... Corporal Kroger? You want to take the band-aid off your tongue now? No. No, I've already tried that and so has half the platoon. You cannot get high off the band-aid adhesive, check? C'mon people, cut it out and listen up.

So. We got our orders and are moving out at 1830 hours to defend Pvt Healthcare. Yeah, I know. Quiet down, folks. Don't like him much neither... Kroger? The probe? Get the hell away from PFC Lewis and lose the probe! The probe doesn't go in there, it goes back in your medikit. He does? Well I don't want to hear about it. What happens in your foxhole STAYS in your foxhole. Foxhole! Yes, you're foxy. And you have a nice tongue depressor. Hoo boy, can you please let me finish??? Sheez!

Back to Private Healthcare. He'll never make PFC if I have anything to say about it. Reckless jerk-weed. Anyway he's stormed the enemy's camp hospital, is now holed up in the vasectomy ward and he needs our support. By the way the enemy demanded his surrender and you know what he said? He said: "Nuts!" Hey, okay HEY it wasn't... stop throwing stuff at me... it wasn't THAT BAD of a joke, huh? Lewis, put down the MRI machine. Kroger, button up your peekaboo sweater and pay attention! Is that sweater authorized, government issue? Hey who cares, I won't write you up. But come to my tent at one-thirty in the morning so we can discuss alternate maneuvers...

 

[Ivor the Engineer]

Medical treatment is either required or not required.

That isn't true at all. As an example, take a 90 year old person who is assessed to be at a significant risk of developing a fatal stroke. The treatment available would lead to severe side-effects that would drastically reduce their quality of life. Should the patient be given the treatment?

This is a real example, although I forget whether it was a stroke that was the danger, and it was the treatments that were prescribed for the side-effects of the treatment that were drastically reducing the quality of life.

This story highlights how important it is that physicians give unbiased advice to their patients. Only the patient can decide if this kind of treatment is required or not after weighing up the advantages and disadvantages.

As I said before, flu vaccination is a poor example because it can be argued it is not a medical need, rather a wanted risk reduction.

Arguably, all treatments are 'risk reduction'. From antibiotics to pills that reduce blood pressure.

Yes, no treatment is 100% effective and no diseases have guarenteed outcomes, though many do come close.

Then I think you substitute one moral hazard (the risk of a patient not being able to afford treatment and going without) for another (the risk of a physician not delivering beneficial treatment because they are paid the same regardless). I don't think that is a smart solution. I think the "hybrid" represented by the UK NHS is superior to both of those.

That bears repeating. I also think it is wrong to presume that Doctors have to be shielded from the profit-motive lest they start turning patients away. It is presuming that no doctor would work 'pro-bono' or that they wouldn't feel ethically bound to help the needy.

It is presuming no such thing. Fee for service is a conflict of interest. Refusing to treat patients based on their ability to pay is incompatible with medical ethics. The hybrid system for NHS GPs that Francesca seems to prefer raises another moral hazard: get as many patients through the office doors to maximise revenue at the minimum expenditure. Effective treatment becomes secondary!

I know lawyers, physio-therapists, occupational therapists, engineers and financial planners (all of whom work in profit-driven industries) who volunteer their time to help the needy.

Good for them (and those they help).

 

[Ivor the Engineer]

What makes you think it's just Americans? Do you truly believe that Canadians, British, Australians, Dutch, French, etc. wouldn't do the same thing if their system permitted it? If you believe that, then explain why Americans are so inherently different.

No, I don't believe Americans are fundamentally different.

It's nothing to do with being Americans, it has to do with simple human nature, and a system with a huge, exploitable loophole.

I agree.

And this is hardly limited to the medical industry. It affects every major industry in the country. It indicates a need for tort reform, not for socialism.

So how is that a defence of private healthcare? You seem to be making my case for me by stating human nature is to be greedy, and systems need to be set up so this inherent greed does not significantly disadvantage other people or groups.

 

[Gurdur]

.... And this is hardly limited to the medical industry. It affects every major industry in the country. It indicates a need for tort reform, not for socialism.

Luchog, IMvHO this is bollocks. Could you please give some actual data to show what percentage of American health costs are caused by legal problems/insurance against suits, and show therefore that that plays a significant role in the reason why Americans have to pay on average as taxpayers more than twiceas much per year than an average French, British, Danish or German taxpayer for the equivalent level of healthcare? And explain why 100% of French, British, Danish and Germans are covered by health insurance, but only 85% or less of Americans are?

I'm saying the tort matter is a red herring and is immaterial to the real costs. Please feel very free to prove me wrong.

 

[Thanz]

However, US health care costs are driven up by absurdly litiginous climate which does not exist in Europe. Without it, US costs would have been much lower.

The absurdly litigious climate has been, in large part, fostered by the lack of a universal health care system. Let's say some dude slips and falls and breaks his leg, and he doesn't have medical insurance. He needs to go to the hospital and is eventually charged $20,000 for the services he receives. He is now in the hole $20,000 that he really can't afford. So, he sues the building/store owner/ city or whoever to recover these medical costs, even if he thinks it was just an accident as he really needs the money to pay off the hospital. He goes before a jury, they sympathize with his plight, and he gets some cash. And this cycle continues.

On the other hand, the same guy breaks his leg in Canada but has no $20,000 medical bill. He recognizes it as just an accident, but doesn't have a huge financial incentive to sue, so he gets on with his life without suing. And therefore you don't have a huge litigitious climate.

 

[gtc]

This story highlights how important it is that physicians give unbiased advice to their patients. Only the patient can decide if this kind of treatment is required or not after weighing up the advantages and disadvantages.

With the doctor.

It is presuming no such thing. Fee for service is a conflict of interest. Refusing to treat patients based on their ability to pay is incompatible with medical ethics. The hybrid system for NHS GPs that Francesca seems to prefer raises another moral hazard: get as many patients through the office doors to maximise revenue at the minimum expenditure. Effective treatment becomes secondary!

You say it is presuming no such thing and then you post something that does appear to be presuming just such a thing.