SHOULD DOCTOR'S FEES DEPEND ON PERFORMANCE?

Reading related argumentative essay: “Should Physician Pay Be Tied to Performance?” The Prop Room

Certainly in the past and even recently, the profession parents dreamt of for their precious offspring was the law or medicine. There are two reasons for this preference: respectability and good earnings. The fee for service system we are all familiar with guarantees a house, a summer house, a car and a healthy bank balance to a lot of doctors who can send their kids to private schools and enjoy every luxury. The patient on the other hand may need to trek back to the hospital for reams of tests, pay through the nose for a host of procedures he later finds out he doesn’t need. God help him if he has no health insurance.  This current, seemingly corrupt system cannot be allowed to continue; providers of health care should be paid for performance.

One important aspect of Obama’s health care bill involves reimbursing doctors in accordance with patient satisfaction surveys and how well they comply with procedures for patient care. Such a system would remove the incentive to do unnecessary tests, confine people to hospital beds for no good reason and many other bad incentives. Critics argue that there are far too many opportunities for doctors to game the system like setting the standards purposely low or altering the wording on patient charts but these and similar hitches can easily be circumvented by not allowing the doctors themselves to set the standards and giving doctors boxes to tick rather than reports to write. Just because there are certain hiccups, it doesn’t mean the system needs to be scrapped; it means the glitches need to be fixed.

Critics have also been clamoring that a physician’s performance is far too complex to measure and that due to the team work that goes on, it is hard to determine where one doctor’s responsibility ends and another’s begins. Who said anything about having the same standards for each branch of medicine? While death rates could be a good yard stick for surgery, it wouldn’t do at all for family doctors. The criteria will have to be custom designed. That the current system is out of control and some checks need to be applied goes without saying and paying for performance certainly fits the bill. Undeniably there are problems that need to be ironed out and let us face it, most things are better than what we currently have.

It is also argued by critics that paying for performance will weaken or even prevent doctors from trying to do a good job just for altruistic reasons or for the satisfaction of doing a good job. One thing that is being overlooked here is the psychology of scientists and doctors. There comes a point for every man or woman of science when everything fades away and all that remains is the problem: how to stem the bleeding for example or how to make the sutras hold. There is also the case of seemingly intractable problems where human genius is pitted against the disease; doctors and other healthcare professionals are not quitters. No amount of paying for performance will kill these instincts.

To sum up, there is far too much wrong with the current system of fee for service to continue with it. Paying for performance is a much fairer system despite the problems it sometimes presents. Shortcomings naturally emerge when any complex procedure is being tried for the first time. The thing to do in this case is to iron out the problems not go back to a system anyone can see doesn’t work.

Provided by: The Oracle