1 Carrot Replaces Another, And So It Shall Always Be


John A. Marcille

It happens over and over. Somebody has a clever idea for a system that will promote better care and/or lower cost. The health care system as a whole embraces the system, uses it for a while and then finds problems that were not envisioned, or were minimized.

Global capitation encourages primary care doctors to tackle specialty care for which they are not trained. Preauthorization wastes their valuable time and irritates doctors in other ways. Genetic screening may put patients at risk for losing affordable health care coverage.

So it goes. Contributing Editor Bob Carlson’s cover story on the gradual demise of a number of financial incentives offered to physicians is another case. The theory here is that incentives to hold down costs may also be incentives to limit care. There is some truth to that, and so courts are stepping in to protect the patient, who too often is a pawn in a game played by employer, health plan, and provider. Sometimes the problems seem larger than they really are.

Many medical groups, in fact, are not happy with this trend. They’ve been able to balance budgets with care, and do the right thing by everyone, and now they — and society, which will pay more for less — will suffer.

Still, new techniques will be advanced and some of them will work, as have the concepts of centers of excellence and treatment protocols. What’s so attractive about this kind of approach is that quality — which everyone wants — comes first, and cost management follows when the correct thing is done at the correct time. The same will be true when (hopefully) we make some progress in suppressing the enormous number of medical errors that injure patients and jack up cost.

The health care system is more than just health care companies. We’re all participants; we all have rights and power. Replacing one tool with another (we like carrots more than sticks) is to be expected and embraced.