I work at an academic hospital, and I've seen how the incentives drive policy. Frankly, it's terrifying.
> Nobody at an academic hospital makes money every time you get sick.
Of course they do! Every time you go in for treatment, they make money, and there only incentives for preventative care come from government/Medicare mandates (e.g. hospital readmissions, ACOs.)
Let me color the picture a bit more vividly. At a public pitch competition within the university, a department head--and judge of the competition--laughed at an ML start up: "you do realize we make money from the procedures you're trying to prevent."
> Discharging patients is a high priority.
Hospitals are often penalized for long stays by insurance.
> Doctors are constantly trying to figure out how to do preventative care with the sorts of "frequent flyer" patients that tie up emergency rooms and hospital beds.
Aside from tying up resources, high-utilizers can't afford to pay for services and the hospitals treat them at a massive loss. Naturally, a hospital would like to free up these resources for patients who can pay.
> It's doctor as antagonist.
I never said this, and nor do I believe this. Doctors are victims of this system. I even made the point that doctors hate the EHR because it's been warped by hospital administrators into a billing-centric machine with umpteen documentation requirements at every turn.
For this reason, many who went into medicine for altruistic reasons end up disenchanted with the health system that's been wrecked by those running the business.
> Nobody at an academic hospital makes money every time you get sick.
Of course they do! Every time you go in for treatment, they make money, and there only incentives for preventative care come from government/Medicare mandates (e.g. hospital readmissions, ACOs.)
Let me color the picture a bit more vividly. At a public pitch competition within the university, a department head--and judge of the competition--laughed at an ML start up: "you do realize we make money from the procedures you're trying to prevent."
> Discharging patients is a high priority.
Hospitals are often penalized for long stays by insurance.
> Doctors are constantly trying to figure out how to do preventative care with the sorts of "frequent flyer" patients that tie up emergency rooms and hospital beds.
Aside from tying up resources, high-utilizers can't afford to pay for services and the hospitals treat them at a massive loss. Naturally, a hospital would like to free up these resources for patients who can pay.
> It's doctor as antagonist.
I never said this, and nor do I believe this. Doctors are victims of this system. I even made the point that doctors hate the EHR because it's been warped by hospital administrators into a billing-centric machine with umpteen documentation requirements at every turn.
For this reason, many who went into medicine for altruistic reasons end up disenchanted with the health system that's been wrecked by those running the business.