Misaligned Incentives in America’s Health: Who’s Minding the Store?

Dear Editor,

The editorial dealing with failing health care [1] is interesting and thought provoking. Here are some of the points that came to my mind impromptu, which may probably boost up the health care and also help in decreasing the costs of medicare:-

• WHERE TO START: A start can be made by making medical education much cheaper than it is at present. Anyone who has been burdened with a hefty loan while completing his or her medical studies is bound to make good this huge investment. Moreover a systematic review of pay package should be done regularly. Medical profession is different, requiring total commitment, dedication, time, efforts, untiring efficiency, and above all deep concern and regards for the human sufferings and human life. By preferring to take up a medical career, one can be sure that the person has not considered about financial rewards as much as is made out, since far less efforts could have provided better returns in any other field other than the medical field, had it been the choice and thus otherwise decided at the outset. Try giving a doctor respectable financial rewards/remunerations so that he does not have to worry every now and then and also does not feel hurt when seeing someone doing better with only half the efforts or even less.

• SELF SUFFICIENCY: By making medical education a lot cheaper than its present status, probably there shall be no further requirement of “poaching” doctors and the country can turn self sufficient in this aspect. Many students may like to pursue medical career as their first choice but are probably unable to do so for very high initial costs of studies that may be frightening to them. However, the criteria of selecting only the motivated and the best should be followed.

• RESTORING & IMPROVING COMPETENCY OF FAMILY MEDICINE: Make the discipline of Family Medicine more potent and versatile. A patient of any age or sex should feel comfortable walking up to a Family Medicine expert for any disease involving any part of body or any of the body systems. Probably because competency is restrained, by way of established conventions, legislations and possibly due to fear of legal consequences, Family Medicine practice seems stifled. Efforts to make it flourish may be set in motion and further dichotomies and branching of super- specialties need to be avoided. Patients should feel that once they visit their Family Medicine specialist, their problems shall be taken care of, without undue need of further referrals to a super-specialist. Laboratory and radiological backup may be provided so that once a diagnosis is reached, Family Physician can straight away prescribe the needful management. Patients requiring hospital admissions and care should be referred and opportunity to seek second opinion should be freely available. Strides in e-health and information technology can help the latter aspect. Evolution began with a notochord that became the backbone. Family Medicine should retain its present form of being a central structure around which the complete medicare revolves, rather it turning back into an indistinguishable jelly.

• REJUVENATION OF TERTIARY CARE: Rejuvenation of District Hospitals will provide the required backing to Family Medicine practitioners and it can provide the secondary and tertiary levels of care. Establishment of super-specialty hospitals catering for defined geographical zones can provide the required super-specialty support.

• DRUG MANUFACTURING: Let the pharmaceutical companies continue producing better products. However, once a “prototype” is produced and duly vetted, the same may be handed over to the government for mass production in its own factories/companies, that may be established. This will bring down the costs of drugs as well as will encourage pharmaceutical industries to keep looking for better and more effective remedies and shall be freed from the pressures of their marketing and distribution.

• HEALTH INSURANCE: Health should be retained as a state subject. Health insurance can be outsourced a single agency or taken over by the government itself, thereby providing conformity and universality. Although profits will be less, but shear volumes can keep the coffers overflowing, making it more accessible and affordable to all. Ideally the poor, orphans, unemployed, displaced, and the old and should keep getting free health care.

• OTHER COSTS CUTTING MEASURES: Over-care, over-investigations and over-prescribing should be avoided to cut down unnecessary costs. These are not helpful to patients also. Further, self-help wherever tenable, should be encouraged.

• END RESULT: End result would be a better health care, universal at that, with far less government spending and reduced calls for separate budget allocations. It shall also reinstitute and restore patient confidence and improve clientele satisfaction levels, simultaneously reducing the spiraling costs of medicare.

With warm regards.

Reference:

1. Teutsch SM, Berger ML. Misaligned Incentives in America’s Health: Who’s Minding the Store? Annals of Family Medicine 2005; 3: 485 -487.

Competing interests:   None declared