It might be easy to conclude that anyone who wants to reduce the role of the profit-motive in healthcare must be either an extremist or a fool. Upon reflection, however, it becomes clear that we are experiencing an era of overtreatment in healthcare (see, for example, Dr. H. Gilbert Welch’s piece here) and one area where it is particularly apparent is in the management of chronic pain. While there are likely many causes of overtreatment, one of them surely is the profit-motive that occurs within a fee-for-service model of reimbursement.
In the last post, we looked at the influence of money on your healthcare providers’ recommendations. We saw that in a fee-for-service model of healthcare, which is the predominant model in the U.S., individual providers, clinics and hospitals get paid based on the number of patients they see and the number of procedures and tests they perform. In other words, the more patients a provider, clinic, or hospital sees or the more procedures or tests they perform, the more they get paid. As such, a fee-for-service model of healthcare incentivizes productivity – providing more care leads to making more money.
One of the more common sentiments that patients express to me is that they have come to the conclusion that money influences healthcare recommendations. After reflecting on all the years of chronic pain and all the years of failed treatments, many of which were tried multiple times, they have concluded that the business side of healthcare played too much of a role in their own care. They are now disappointed, angry, and jaded about how much they trust healthcare providers.