Their incentive then becomes to keep a good relationship with you so you continue to pay them. The best way to do that is to keep you healthy and happy.
> There are, however, two big problems with this approach. The first is that even though my life may be worth $10 million to me, most of the (huge) insurance premium to pay for this insurance would be wasted from my point of view -- there probably is not one person to whom I would want to give this much money when I die. The other problem is moral hazard -- heavy insurance may reduce my incentive to keep myself healthy, and may even create incentives for my relatives to try and hurt me. It might be a problem if I could only give my doctor a 50 percent interest in my life by taking away 50 percent of my own interest, or by giving a minus 50 percent interest to my relatives.
I get the super high-deductible catastrophic with HSA plan from my work, and then I pay $135/mo for my whole family for the DPC doctor (I could pay that $135 with my HSA and have it be on pretax money, but I'd rather invest my HSA pretax right now). The total there is less than any other insurance available to me. If I ever need anything, I just call or email my doc, most of the time we just do a (secure) video chat and I'm done and I don't need to make a trip in. If it is more severe, I can easily get a same-day appointment. He knows me, knows my history, and has an incentive to keep me healthy. The healthier I am, the more I pay him and don't see him.
I love the model!
I am sure if I asked my mates they would all disagree with me on this. Bad luck for the patients.
Having sued a doctor once, you might never be able to get medical treatment again.
No, I know they don't.
The idea of actual healthcare being dependent solely on optimization of greed is, of course, ludicrous.
1. The doctor's stake is pretty limited.
The old royal court doctor model is the perfect model for this. It's based on the doctor having very few (one?) patient. If the patient dies, not only do you risk your substantial income and high status, but you might even lose your life if the royal family gets suspicious enough.
It's a good solution if you're very rich. Much richer than the average doctor.
2. When you have more than one patient, at some point you probably earn more by treating less.
The less work you spend on each patient, the more patients you can take on. The more patients you can take on, the more you earn. If you simply stop treating patients - "you're perfectly healthy, don't worry" - you can basically take on an unlimited amount of patients and collect their fees until they perish. (This sounds like a caricature of the US insurance system, from my western EU perspective.)
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What about this convoluted system:
- The doctors get paid a recurring fee that starts small and increases the longer you keep a patient around. This counters the problem that patients can just be replaced by a younger and healthier patient.
- The doctors get assigned patients randomly. This addresses the problem that doctors would choose young and healthy patients.
- The doctors can only have a certain number of patients at once. This makes each patient more valuable, and the doctor will be incentivized to actually treat patients, instead of having as many as possible.
Oh wait...
Now, the problem is that a young, ambitious, greedy doctor would be incentivized to cull their set of patients and select for the most viable ones in the long run. This actually incentivizes them to kill off patients with minor defects?
I’ve found that my employer-provided health insurance is less than worthless for routine health care. I actually pay less by going to providers who don’t accept insurance — even though I maintain bare-minimum coverage and an HSA. I don’t think I used my health insurance at all this year — at least not enough to come close to meeting the deductible.
My primary care doctor uses this model — I pay $300/yr for basically unlimited access. I have a therapist who I pay $75 a session. I use GoodRX for prescriptions and get better prices than the post-deductible price on my insurance plan.
Basically, I pay less out of pocket by not using my insurance. I also get to choose my doctors, and they treat me as an actual patient rather than a number. Health insurance in the US is a scam.
I don't know if overpaying will work, because the marginal value of money goes down the more you have. Once your doctor is rich enough, he won't be overly concerned if you die and the checks stop coming in.
The real answer is the action-movie/not-that-uncommon-in-reality answer: Credibly promise to shoot the doctor if you die, or to shoot the doctor's family members.
Easy fix... "Just be wealthy!" lol... :|
I've paid for the absolute best insurance I could find this year and gone to doctors my entire life that simply don't care. I've had everything from colonoscopies to MRIs done and I haven't spent more than one day in my entire life in a hospital overnight in over 40 years.
Many would say I'm pretty healthy, but who knows?
It usually seems like doctors peddle as much fear as web MD now in order to drive me through the service bay of fees every time I have an ache or troublesome pain.
If it's any consolation though, my dentist, my auto maintenance shop, my lawyer, and even my local supermarket want a constant revenue stream out of me because they have a pipeline of service that they know they can get a customer hooked on if they coordinate their efforts and make their pricing variable based on being properly opportunistic.
A lot of the tactics the health care industry regularly uses to sell services (and drugs of course too) are from the nefarious book of street drug dealers... In a bad economy, the scams and opportunism are ripe. Getting a second opinion is often VERY EXPENSIVE as well.
Be careful my friends, sometimes it's better to face your fears of "WebMD prescribed" death head-on rather than to bankrupt yourself, because if you don't die, living broke or in extreme debt can be a "silent killer" and harmful mentally and physically to you too. Maybe marry a doctor... That might cut extreme health care costs... By about 5% if you're lucky... :P
Or have all doctors employed by the state on good fixed pay
Edit: The smarter person will charge you while you are healthy and not treat you when you need it, or underdeliver for the expectations.
“I’m not going to kill you, but you would surprised how much suffering you can live through.”
(I think the actual answer to the question in the OP is, at least in part, to license more doctors. Then the cartel doesn't have as much pricing power and medical care is less of a luxury good. The rich person should really hire a lobbyist.)
https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physic...
The 80s/90s/00s were probably the golden years for them, but they got in the political spotlight, and combined with the decreasing proportion of young to old people, the government is going to push down cuts to whoever lacks political power to push back. Such as smaller businesses like independent doctor offices and pharmacies.
The government has already increased supply by letting Nurse Practitioners and Physician Assistants do stuff that doctors used to do, and I suspect a lot more price discrimination is on the way. Expect the average quality of care to fall (may not be a bad thing if overqualified people were treating pink eye), and paying more will result in being seen by someone more qualified.
If I pay doctors $400,000 a year to work 80 hours a week and then double the number of doctors and pay them $200,000 a year to work 40 hours per week, the quality of care would almost certainly improve but costs would be constant. And actually, do we pay doctors a premium for those overtime hours where they're actually probably less effective? If so, our costs would go down as quality of care improves.
The AMA does not want more competition and lower income per doctor.
Also, increasing class sizes is not without its down sides. Pharmacy schools cashed in and blew up the number of pharmacists in the last 10 years, and now the pharmacists’ employers have so much power in the negotiations due to so much supply of labor, that they can make pharmacists accept metrics which pharmacists know are excessive and unsafe since no one can possibly do the job properly in the time they are expected to check the medications and counsel people in.
A pharmacist family member says the law is to counsel patients, but the reality is anyone who did that would be fired and replaced so, in reality, people are not getting the counseling they deserve when they pick up the medications, and pharmacists are not able to properly double check the doctors.