Wrong Incentives Undermine Medical Diagnoses

In medicine, proper diagnosis is essential to effective treatment and healing, so I was disturbed (but not surprised) to see yet another example of how incentives in the U.S. health care system undermine proper diagnosis. Today’s example comes from the Wall Street Journal:

Many in health-policy circles have focused on how the current health-care payment system is helping create shortages among primary-care doctors, internists and others on the front lines of medicine. But often lost is how the system is endangering some of the country’s most highly trained specialties as well.

Endocrinologists, rheumatologists and pulmonologists — specialties that also don’t involve performing many procedures — face acute shortages. Many of the severest deficits affect children. Though nearly 300,000 children in the U.S. are diagnosed annually with juvenile arthritis, lupus or other complex rheumatic diseases, there are fewer than 200 pediatric rheumatologists to take care of them, according to the U.S. government’s Health Resources and Services Administration.

I think that the proper measure for rewarding health care practitioners and health care organizations is “value for patients,” where “value in health care is the health outcome per dollar of cost expended” (Porter & Teisberg, Redefining Health Care, 2006: 4).