Hacker News Reader

Comment by pugworthy | Hacker News Reader

It would be interesting if the "no cure, no pay" principle from right of salvage could be applied to medical treatment.

Something like this...

> The "no cure, no pay" principle is a fundamental concept in medical law where a doctor (the party assisting a human in health danger) is only entitled to a reward if the healing operation is successful in saving the person or part of person (life, limb, sight, hearing, etc.). If the operation fails, the doctor receives no payment, regardless of the effort or expense incurred.

View on HN

A very large portion of medicine is for treating symptoms, improving quality of life, making someone comfortable, etc. so you’d sometimes defin the problem needs fixing as the illness, the symptom, something else. But then part of medicine is identifying what the illness is, what causes the symptoms, etc. additionally, there is no “fix” for illnesses. Everything has a list of approaches that doctors choose from based on the context - IE strep throat may have prescription A as like 1 (the first/best choice generally), but the patient could be allergic, have used that medicine in the past unsuccessfully, etc.

It would be an interesting application of that principle, but I think it would lead to a rapid deceleration in medical research and advancement since the state of the art requires so much experimentation even at the clinical and practical level.

Research institutions and universities would dramatically reduce the amount of testing they're doing if they can't get any compensation for the shit they're throwing at the wall.

All you would get is even more insurance overhead and even higher nominal prices. People who pay cover people who don't, and doctors will get insurance to pay for all their failures.

Oh yes all kinds of ethical issues as well.

I think the author's (pugworthy's) intent was to disincentivize doctors who take advantage of fee-for-service.

For example, a few years ago, I started getting Plantar Faucitis. (Basically, foot pain that happens in middle age.) My doctor sent me to a podiatrist, who basically told me to buy new shoes, use inserts, and stop walking around barefoot. That worked, BUT:

The podiatrist also pushed me to do a silicon injection (as in they offered it while they were pulling out the needle and pushing it into my foot), pressured me to come in monthly, and wanted to write a prescription for a painkiller that I didn't need and had side effects. It was clear they were trying to increase their patient load and services as a way to get more revenue.

That sounds like a sure-fire recipe for adverse selection.

Reply on news.ycombinator.com