I the interesting thing to consider is what happens to the hospitals that do terribly, but not so poorly that they should be shut down. The publication of their rating will start causing doctors and patients to avoid them. In our fee-for-service model, this causes the hospital to starve and enter a vicious feedback loop.
Perhaps we should have an independent commission that has the ability to perform an outside investigation into these cases and attempt to understand what's going wrong. For hospitals that are under-resourced, they would have to power to increase allocations. On the flip side, it could shut down the ones that are irreparably broken that can safely be removed from a region.
Also, we should do away with fee-for-service for good. It is the worst bag of incentives this side of the line between healing and hurting.
I don't understand how this helps hospital management once it enters the feedback loop. It does incentivize them to not get there in the first place, but I bet when you analyze the tradeoffs they make to forestall it you won't be happy either.
This is especially a problem is when you have a lone hospital serving a poor area. The patients don't have money, maybe they don't have insurance. If the hospital starts cranking out bad results, it'll just deteriorate.
The market model only kinda works in theory for wealthy populations with multiple hospitals nearby.
There's a market for cheaper, less safe cars. There would be a market for cheaper, less safe hospitals - in fact there already is, we're just embarrassed to talk about it openly.
Think carefully about what you're saying. The rich get to live longer and healthier and the poor get substandard healthcare? The poor are the ones that need to work.
what's the alternative to fee for service? At the end of the day, even if you abstract out these costs to bundled payments or other things that we saw in ACA, there's still a price attached to every service provided. Wouldn't that be the only way for the government to how much to budget for healthcare costs?
The alternative is medicare for all bundled with something that looks like per capita allocations to take care of a patient population. Patients pay nothing at the point of service. Hospitals must drive down costs to make a profit. If they start cutting corners, they lose their bonuses. If they really aren't making enough money to do their job and can prove it to an independent board, their allocations can be increased. You can imagine some kind of bonus system based on YOY improvement or maintenance of patient outcomes.
That doesn't work for a single hospital in isolation since hospitals mostly only treat patients that present with serious problems. If you're going to use a capitation payment model then it has to cover a complete integrated delivery network including acute care, ambulatory care, laboratories, imaging, physical therapy, etc.
There's just no practical way to do it. If a payer wanted to do capitation payments to a single isolated acute care hospital how would they even figure out what to pay and what incentive would the hospital have to take that deal? In order for something like an accountable care organisation (ACO) to work they have to control all aspects of patient care so that they have a chance to address problems early, long before the patient is admitted to the hospital.
I think this is similar to the idea of Health Justice that I've heard Tim Faust talk about. The reason the hospital will take the deal is simple, it's the only deal by law and the private insurance payers will be eliminated.
We don't live in a dictatorship and there's no way politically to force them to take that deal. Major changes won't be made to the healthcare system without at least rough consensus from the wealthiest and most powerful stakeholders, including major hospital chains. Even under single payer systems, hospitals are funded at least partially based on the actual amount of care delivered.
As you can see with the tax plan being rammed through, the minority of the wealthiest can ram through whatever they damn well please. We can do the same to them. We outnumber them.
Any yes, we can rationally allocate resources to ensure care is adequately delivered.
Perhaps we should have an independent commission that has the ability to perform an outside investigation into these cases and attempt to understand what's going wrong. For hospitals that are under-resourced, they would have to power to increase allocations. On the flip side, it could shut down the ones that are irreparably broken that can safely be removed from a region.
Also, we should do away with fee-for-service for good. It is the worst bag of incentives this side of the line between healing and hurting.