Experimental study shows physicians trade optimal patient care for money | Hacker News Reader

Experimental study shows physicians trade optimal patient care for money

theincidentaleconomist.com

36 pointsgronkie24 comments

The participants were medical students--not physicians. The title should reflect that.

The gap in experience is significant. A 3rd/4th year medical student, like myself, has had limited clinical exposure(think months) and is wholly incapable of making decisions regarding patient care.

A student's lack of experience can explain why he/she might over investigate healthy patients and under investigate sick ones--he/she can't tell the difference. A physician, in comparison, has a protocol for how to work up a patient's chief complaint far in advance of ever meeting the patient.

Most importantly, students have no concept of medico-legal consequences of mismanagement. This is a huge incentive for physicians to work up all patients the same way. Anyone can sue. Whenever anyone suggests adopting XYZ country's medical system in place of our own I kindly point out that we would have to retrofit their legal system as well.

1 - You don't need any medical knowledge to just pick the row with the highest value in the last column

2 - Aren't those outcomes exactly what we see empirically?

Doctors are human, and respond to economic incentives just like all other humans. News at 11.

This is probably true with the current setup, but traditionally doctors had a particular social position and professional mythology around them. I'm not sure if it was ever really true that they didn't respond to economic incentives, but the perception (both external and among doctors themselves) was that they had a sort of above-the-fray perspective where they were supposed to use their learned judgment for the betterment of those under their care, rather than engage primarily in business. Sort of the same thing expected of priests, professors, sheriffs, etc.

>traditionally doctors had a particular social position and professional mythology around them. ... >Sort of the same thing expected of priests, professors, sheriffs, etc

yep. such posturing allows to keep price ("economic incentive") higher

Quite true: http://en.wikipedia.org/wiki/Hippocratic_Oath

Doctors are human, and respond to economic incentives just like all other humans.

And like all humans, they also respond to non-economic values when they are participating in a culture that reinforces those values. I think medical ethics has been eroded, both by the prevailing American cultural attitude that making money is the highest and best purpose to which one's life can be put, and by rising educational costs which mean that most doctors start their careers deep in debt. As long as we regard medicine as just another market, we'll see this kind of mismatch between profitability and patient well-being.

As long as we confuse how we'd like things to be with how they are, we're doomed to waste a lot of money that could be put to better use. Doctors are human, humans are most reliably motivated by self interest, the key to good care at good prices is to align economic incentives. Certainly, doctors care, and the social prestige means you can underpay doctors (which selects for those less motivated by money than by the desire to help people), but that does not remove the economic aspect.

...humans are most reliably motivated by self interest, the key to good care at good prices is to align economic incentives.

Is it really 'the key'? Why? You are making exactly the implicit cultural assumption I'm referring to. In a social context, self interest does not equate simply to economic interest. Incentivizing people economically is not the only way to motivate them, nor is it the most effective way. It only serves as a least common denominator, something to use when there are otherwise no shared values between the parties. Economics alone represents a floor, not a ceiling, and is certainly not a sound foundation on which to build a healthy society.

Oh boy. This has proved true to me - but from dental surgeons, not physicians. I've gone through 3 dental surgeons who have opened up the gums above my canine teeth, excavated, charged my insurance $1000's and me $100's [the costs of successful operations], and then failed to fix the problem in my mouth. The problem is an extra tooth growing out of the root of my canine tooth, usually a simple extraction. But I'm convinced the dental surgeons are more interested in letting the tooth grow, destroying the rest of my mouth, so they can later put in more expensive dental implants. I'm highly fed up and am considering becoming a medical tourist to get the offending tooth out of my skull.

You'll find this in any medical field. But, being married to a general dentist, I know that it's very possible for you to find an oral surgeon via a referral that will do as you ask (if it's not putting other teeth at risk). It's generally accepted in their community (from what I've gathered) that if there is a high probability to save a tooth they'll opt for that. Talk to them, if you don't like what they have to say go somewhere you feel more comfortable with the treatment plan.

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So, you knew your troll post would be downvoted, as evidenced by your prediction, and yet you still post it and complain about it when it happens?

It's not just that your post contained no thought other than "Government bad!"... your post had absolutely nothing to do with the article.

From TFA:

"In a controlled setting, the researchers asked medical students to choose the quantity of medical care to provide to hypothetical patients enrolled in either fee-for-service (FFS) or capitated insurance plans"

Capitated and fee-for-service are two methods used by private and public entities to pay for health care. The article was about how doctors behaved (or at least how medical students said they'd behave) under each of those two systems. I don't find the experiment convincing, but I can read well enough to know it had nothing to do with whether the payment was publically or privately funded.

An anti-Obama bumper sticker would be a much more appropriate forum for your opinions than this thread.

I didn't downvote but _delirium is correct that you didn't provide any details to an argument. After reading your first sentence I was expecting some examples (maybe the example that health insurance plans can't cross state lines, HIPAA, etc.). The health industry seems to be pretty profitable so I'm not sure what perspective you are coming from when you say "damage".

On a side note, don't set yourself up for a downvote by only providing an opinionated comment and then play the victim card stating that a biased subsection of the community is out to get you.

I should add that I think people should not downvote you just because they don't agree with you, but they should be allowed to downvote you if you are not providing value to the conversation.

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Yeah, I'm on the fence. Sometimes I see great back and forth conversations and sometimes I see people buried into the ground. I think it's still work laying out where you are coming from and if others downvote you based on disagreement then it's their problem.

As for my comments of "out to get you" or "victim card" I think I should have said, "don't become a self fulfilling prophecy". I don't necessarily think you are playing a victim card. Either way, keep participating. You've at least created quite the discussion thread.

The US has been great for the industry. They subsidize it more than the UK, which is almost entirely socialized and free.

The UK NHS is "free at the point of delivery" - not "free".

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You said "Considering the damage the US government has done to the industry..."

I downvoted your post because it didn't really make an argument; same as I'd do if the post was a typically reflexive blaming of "insurance companies" or "greed". I don't think hearing either the left-leaning or right-leaning soundbytes on medicine yet again is useful to anyone.

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It isn't, and that's not at all what he said. As he said, your post didn't make an argument. Your first post was inflammatory without substance, and this post is inflammatory combined with a strawman. Yes, on HN that behavior will get you downvoted.

> I've attempted to 'argue' Austrian style economics here before

Careful what you claim. Your account is brand new and shows no such comment history.

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