NPR story finds the gaping flaw in 'fee for service' medical model

“If you pay people more, the more things they do, they’re going to do more things,” says Smith.

The U.S. health care payment system rewards doctors for taking action and doing procedures. This reality is so powerful that it hasn’t just changed the individual behavior of doctors. Keller says that the specialties themselves have changed, bending like flowers to the sun, moving toward the source of heat.”

I can all too well relate this to the breast cancer experience. Far too many doctors out there treating cancer patients are working on the ‘fee for service’ model and far too many women are getting more biopsies, more invasive biopsies, more CT scans, more MRIs and simply more procedures. What they’re not getting are better outcomes.

I’ve watched this quietly over the years here in Reno via a breast cancer survivor group. I’ve compared it to the salaried model at The University of Texas, M. D. Anderson Cancer Center in Houston where I got all of my surgery and treatment. I can tell you, the top cancer center in the world, they are not in a hurry to do procedures of any kind. They do them when the science says the outcomes are going to surely justify them, not to satisfy a patient or the bottom line. More isn’t better. Better is better.

Thanks to alert reader, Ronda, for putting me on to this important story.

Listen to the story here:

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How to reform healthcare reform: Science Friday

Talk of the Nation, July 10, 2009 · 11 minutes 30 seconds

Writing in the New York Review of Books, former editor-in-chief of the New England Journal of Medicine and retired M.D. Arnold Relman says President Obama’s health care plan won’t work. Relman outlines the changes he thinks are necessary for success but missing in the plan.

Relman makes the excellent point that as long as healthcare is exercised as a for-profit model, no plan, including Obama’s, will work.

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