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The Greedy Doctor Problem

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Re: The Greedy Doctor Problem

#21

Post by pc86 »

gwerbret wrote: post #9
dstroot wrote: post #7

Earlier quoted context omitted.

The doctor will purchase "refund insurance" and pass that cost along in the monthly retainer.

Fair point, but if the client does develop a preventable condition, it would be easy to show this is due to dereliction/negligence on the part of the physician, so the insurance would not pay out. If the client came down with a condition and the physician was not negligent, the condition would likely be non-preventable, wherein the refund clause wouldn't apply, anyway. Thus, regardless of outcome, insurance can never…

How is it "easy" to show negligence?

Re: The Greedy Doctor Problem

#22

Post by oaktrout »

chriscross wrote: post #15
gwerbret wrote: post #3

Earlier quoted context omitted.

I agree with the idea of paying the doctor a flat fee every month, but in my variant, the doctor has to repay you the entire sum you've paid to date, with 10% interest, if you succumb to any preventable illnesses; in other words, the doctor now has some real skin in the game. S/he becomes motivated not only to keep you well, but to keep the fees reasonable.

That’s horribly ignorant considering that many diseases have a large genetic component and people are rarely 100% compliant with the things they need to do to prevent a disease. Even when a doctor lets them know how to prevent the disease. How would this work for a disease, for example, like Alzheimer’s where the onset is much earlier in life (40s) but doesn’t manifest until much later in life and has no diagnostic t…

Seconding your view points. If a patient dies from a hypertension related cause (say stroke), and the patient has not followed the strict low salt diet the doctor recommended, does the doctor pay for that? At what point does the doctor stop seeing patients who do not follow their recommendations to the exact letter?

Re: The Greedy Doctor Problem

#23

Post by evancoop »

Let us posit that the patient's goal is to remain alive and well (maximize quality-adjusted life years). Let us posit that the doctor's goal is maximal renumeration. Cannot we simply compensate the doctor quarterly as a function of quality-of-life during that quarter along with some fixed retainer. Now the doctor hopes we remain alive and well as long as possible?

Re: The Greedy Doctor Problem

#24

Post by mattficke »

kuiper0x2 wrote: post #2

The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not. Well above what they would earn elsewhere. Their incentive then becomes to keep a good relationship with you so you continue to pay them. The best way to do that is to keep you healthy and happy.

This is basically the Kaiser model. Kaiser's doctors are salaried, rather than getting paid per procedure. Works pretty well!

(I think the actual answer to the question in the OP is, at least in part, to license more doctors. Then the cartel doesn't have as much pricing power and medical care is less of a luxury good. The rich person should really hire a lobbyist.)

Re: The Greedy Doctor Problem

#25

Post by jtbayly »

cfu28 wrote: post #11
kuiper0x2 wrote: post #2

The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not. Well above what they would earn elsewhere. Their incentive then becomes to keep a good relationship with you so you continue to pay them. The best way to do that is to keep you healthy and happy.

This assumes that actions that make a patient happy also make them healthy. There’s a risk that pursuing patient happiness can come at the expense of patient health. The doctor may be more inclined to keep a patient from switching doctors to keep getting paid.

Such as doctors that prescribe sleeping meds to rich clients that... end up dead.

Re: The Greedy Doctor Problem

#26

Post by skeeter2020 »

BerislavLopac wrote: post #12
gruez wrote: post #6

Earlier quoted context omitted.

Isn't that just handwaving the problem away? eg. "high corruption? the ideal solution to move to a country with a great civil service"

Generally speaking, absolutely. But the original problem statement begins with "you are very rich", which changes the rules a bit.

Very rich people will do far better in a private or blended system than a country with only a public system. Your best approach would be to triage your own health requirements: (1) spend as much as needed on preventative & health components, (2) pay a retainer or monthly fee to a private health network, (3) pay cash immediately for any rare, critical or emergent needs. You can get #1 in lots of countries, #2 in fewer and #3 in a handful including but not restricted to the US. As a Canadian, if you are super-wealthy you need to likely leave the country for #3.

Re: The Greedy Doctor Problem

#27

Post by sampo »

> Should you trust someone's advice, when you can't pinpoint their motivation? As a Ph.D. student, I run into this problem around three to five times a week, when interacting with colleagues or my advisor.

Maybe this should be named "The greedy thesis advisor problem"?

Re: The Greedy Doctor Problem

#28

Post by throwawaygh »

sampo wrote: post #27

> Should you trust someone's advice, when you can't pinpoint their motivation? As a Ph.D. student, I run into this problem around three to five times a week, when interacting with colleagues or my advisor. Maybe this should be named "The greedy thesis advisor problem"?

This is very different from the Greedy Doctor problem.

Why? Because, generally speaking, the answer to this question is "it doesn't matter". A student will never get a job in academia without their thesis advisor's good word.

If a student is ready to leave and their thesis advisor isn't ready to let them go, their best option -- assuming they have at least a few publications (for CS) -- is to find an industry job and say "Sorry, my hands are tied on the start date and I need a better paying job for personal reasons. I really wish I could write a better thesis but I think there's enough work here at least to graduate."

(BTW: industry is much better than academia. The work is more interesting, the teaching/mentoring is more rewarding, and you'll make enough to retire in your 40s instead of desperately clinging to a job in the increasingly MBA-ified Higher Education Industry until your 80s. The "Academic Life" sucks pre-tenure anyways. If what you want is the so-called comfortable and care-free Full Professor days, just get financial independence in industry first and then go be a professor of practice or even ad junct somewhere for the healthcare and vacation money... which, aside from pay, are both actually low effort and care free!)

Re: The Greedy Doctor Problem

#29

Post by efsavage »

kuiper0x2 wrote: post #2

The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not. Well above what they would earn elsewhere. Their incentive then becomes to keep a good relationship with you so you continue to pay them. The best way to do that is to keep you healthy and happy.

If we're trying to handle the case of greedy doctors, why would a doctor accept a very sick patient who is going to require a higher-than average amount of care and probably not live (i.e. pay) as long? If they can't pick their patients, how do you protect the unlucky ones who end up with too many very sick patients?

Re: The Greedy Doctor Problem

#30

Post by lotsofpulp »

pc86 wrote: post #20
oaktrout wrote: post #18

Earlier quoted context omitted.

Without malpractice insurance, would doctors be incentivized to not take on risky patients? Risky could be defined as litigious (I know this patient has sued another doctor before) or medically difficult to treat (this patient needs this surgery but they are at high risk of poor outcome due to their current state of health). Having sued a doctor once, you might never be able to get medical treatment again.

Which would also disincentivize ridiculous lawsuits that you'd almost certainly lose.

It would also disincentivize legitimate lawsuits.
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