In an earlier post, I said that health care funding should focus on outcomes, rather than procedures. David Cutler has thoughts along the same lines.
Why don't we pay a little bit more to make sure that people don't have colon cancer rather than pay so that they have colonoscopies...
I want to put the money in a quality improvement fund. And here's the way it works. I use what the clinical literature suggests as appropriate care...And you see how well the doctor followed them. Sometimes they would be process measures, like, did the doctor do something? In some circumstances, like, for example, at a hospital level, many states evaluate how well hospitals do in terms of mortality for common surgical procedures. So you can evaluate outcomes. Sometimes you can measure the satisfaction of the patients. There are a number of different dimensions here. And you assign points. So you might get one point for every time something goes right and you lose a point for something that you didn't do right.
In addition, Cutler has the ultimate rebuttal to those who say the United States gets a bad return on investment in health care. He has some very specific calculations which demonstrate that the returns are high.
For Discussion. What sort of resistance might doctors offer to Cutler's "point system" compensation concept?