David Cutler: belief

Transcript context

…If you were to express that in terms of the model, what’s the limitation in economic terms? Something we can’t measure, something that’s not contractible, or what? I think there are a couple of parts. One part is that every individual insurer has their own system, so the doctor finds it very difficult to customize what they’re doing to every single insurer. They get one set of incentives from Medicare, and another set of incentives from the Blue Cross policy, and another one from the United policy. Even within Blue Cross, it varies, depending on which plan you’re in. That’s one, is that it’s very difficult when it is so diffuse. I think the second one is that many of these are also coupled with systems where you can make more by making sure your patient appears to be sick. Therefore, when they turn out okay, you get a lot of money. A lot more effort nowadays is put into making sure you’re coding appropriately so that you get all the reimbursement for the sickness of the patient, as opposed to saying, “Okay, the patient is what the patient is, and the way I make money is by making sure they’re healthier.” In principle, you could have doctors do both of those — both worry about the coding and about the patient health. In practice, there’s much more effort put into the coding part, which has got a real easy return to it, than there is put into the health improvement part. If we think about very wealthy individuals who could afford any scheme and really care about being healthy, and they have some form of concierge medicine, and possibly even a buyer agent working for them, what do those incentives look like? Or what should they look like?…

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