I think you're overly cynical. Docs don't need monetary incentives for "keeping the patient healthy." They need proof that something is wrong and a simple remedy will fix it and help patients. Not every doc, particularly those with relatively fixed salaries, are rushing to see patients to maximize their personal wealth. I'd think it was financial pressures to reduce costs at the institutional level that create an imbalance between # of caregivers and the # of patients. I've seen some new medical practices (e.g., here in Palo Alto) where you can pay a lot more and get seen by docs with a relatively very low patient load.
One of the few things that has reduced health care costs the past few decades has been the advent of HMOs. Why is that? Because HMOs give a doctor a financial incentive to keep the patient healthy.
No, I don't think I'm cynical. I'm speaking from over 15 years experience in the Critical Care business. I've worked at over 35 hospitals and medical facilities in 6 different states.
And, it's a plain fact of nature. People do what you pay them to do. Just because someone is in health care doesn't change the fact that they want to get paid. And, we should give people financial incentives to give good care. Pay them to do a good job.
A founder gets paid if their company has a successful exit. So, we bust our buts to make a successful exit for our company.
Stock options reward employees for increasing the stock price. So, employees will work to increase that stock price.
If you pay people per hour, they work a lot of hours.
If you salary people without regards to performance, performance drops.
If you pay a person per widget made, they make a lot of widgets.
I'm speaking from experience. The best ER's that I've worked in were ER's where the doctors are paid a base rate and then a bonus for performance based standards. That ensures excellent, efficient practice of medicine. Those are the ER's where the doctors push the nurses to line up more patients to be seen. The ER that I work in now is one of those. I'm working with some of the best doctors I've ever worked with.
I've worked in ER's like that where the group of doctors got paid a flat rate to staff the ER per year. So, if they understaffed the ER, they got paid more. Needless to say the patient wait times in that ER were often over 16 hours. I saw patients waiting a full 24 hours just to see a doctor for a broken arm or a gallbladder attack.
