“How Medical Care is Being Corrupted''

There was an article in the New York Times, "How Medical Care is Being Corrupted," that caught my eye this week.

The two author-physicians write about how the policies and expectations of insurers, hospital networks, and regulatory groups are created to get good-looking statistics which then undermine the ability of individuals to obtain the most appropriate care.

"For example, doctors are rewarded for keeping the patients' cholesterol and blood pressure below certain targets. For some patients, this is good medicine, but for others the benefits may not outweigh the risks."

The authors go on to note that these risks are not insignificant, and may include an increased risk of developing diabetes - no small problem - and increased fractures and falls amidst the senior population. 

Physicians are not awarded based on giving the best care to each patient. Instead they are financially rewarded and receive better online reviews if they meet the targets, and are financially penalized and suffer negative online reviews if they don't meet the targets.

These are not the only financial incentives out there. Insurers will pay bonuses to doctors for using preferred medications, even if those aren't the best option for a patient.

The creepy thing about this is that it's done behind closed doors. A doctor who was frank with his or her patients about the influences swaying his or her decisions would surely be fired.

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The authors acknowledge that some health policy experts "argue that it is obsolete for the doctor to approach each patient strictly as an individual; medical decisions should be made on the basis of what is best for the populations as a whole."

Huh? How is having sick people get sicker best for the population as a whole?

The authors come out strongly against this ideology, stating that "Physicians should never have an incentive to override the best interests of their patients." I agree.

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The posts from this week all have a common theme of how the government and corporations (both medical and consumer goods) are powerful influencers in our medical care system, which frequently does not have our best interests at heart.

From the World Health Organization's fact sheet on the right to health:

  • The WHO Constitution enshrines the highest attainable standard of health as a fundamental right of every human being... 
  • The right to health means that States must generate conditions in which everyone can be as healthy as possible...

It is ironic that here in one of the most powerful and wealthy nations on the planet we have completely failed to "generate conditions in which everyone can be as healthy as possible."

(While this post focuses on the medical care system itself, our nation has also failed on many other counts to create healthy conditions for people. For instance, we subsidize corn which then gets made into corn syrup which then feeds the epidemic of obesity and diabetes. Our cities are made for cars, which creates excess pollution and contributes to our sedentary society, again contributing to our nation's health crisis. The list goes on, and it is way too big to address here in this post.)

As frustrating as all of this is, the take-away for me is, again, that I need to be in charge of my own health as much as possible. Yes, I will continue to use doctors in my care, but I will weigh their advice carefully. 

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This comment of mine begets a topic for another blog post: I am able to do this only after years of practice, and I have the benefit of citizenship, being a native English speaker, having a college degree, and health insurance.

How can a system this backwards possibly be serving the people who need it most?

These perverse incentives serve a few in the short term, but they are shooting the nation in the foot long term. Not only does poor health get in the way of an individual's "Life, Liberty and The Pursuit of Happiness," but it is a huge drag on the economy.

Those who claim that the bottom line should be the metric by which we measure success should have the business savvy to realize that a sick nation is not a firm foundation for financial reward.