Dr Atul Gawande has written another superb healthcare article for The New Yorker. Here are a few key excerpts. (Read the entire article. You won’t be disappointed.)
Historically, doctors have been paid for services, not results. In the eighteenth century B.C., Hammurabi’s code instructed that a surgeon be paid ten shekels of silver every time he performed a procedure for a patrician—opening an abscess or treating a cataract with his bronze lancet. It also instructed that if the patient should die or lose an eye, the surgeon’s hands be cut off. Apparently, the Mesopotamian surgeons’ lobby got this results clause dropped. Since then, we’ve generally been paid for what we do, whatever happens. ….
Health-care reforms—public and private—have sought to reshape that system. …. Today, some ninety “super-regional” health-care systems have formed across the country —large, growing chains of [results-based] clinics, hospitals, and home-care agencies. …. Financial analysts expect the successful ones to drive independent medical centers out of existence ….
Already, there have been startling changes. Cleveland Clinic, for example, opened nine regional hospitals in northeast Ohio, as well as health centers in southern Florida, Toronto, and Las Vegas, and is now going international, with a three-hundred-and-sixty-four-bed hospital in Abu Dhabi scheduled to open next year. ….
Yet it seems strange to pin our hopes on chains. We have no guarantee that Big Medicine will serve the social good. …. In the past, certainly, health-care systems that pursued size and market power were better at raising prices than at lowering them. ….
We’ve let health-care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous. [The creation of chains] … represents our best prospect for change. Some will see danger in this. Many will see hope. And that’s probably the way it should be.
Atul Gawande, “Big Med“, The New Yorker, 13 August 2012.
HT Arnold Kling
Atul Gawande (born 1965) is a journalist, a staff surgeon at Brigham and Women’s Hospital in Boston, Professor of Surgery at Harvard Medical School, and Professor in the Department of Health Policy and Management at the Harvard School of Public Health.
Readers who erroneously believe that Canada’s single payer system is socialized medicine will be surprised to learn from Gawande’s article that the prestigious Cleveland Clinic operates in downtown Toronto. Services offered that are covered by the Ontario Health Insurance Plan (OHIP) “include cardiology, gastroenterology and sports medicine”. OHIP expenses are financed entirely from general government revenue, not from premiums, patient co-pays, payroll taxes, nor any earmarked tax.
