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The Greedy Doctor Problem

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Re: The Greedy Doctor Problem

#31

Post by khafra »

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.

For specifically the doctor version of the principle-agent problem, Robin Hanson published an incentive-compatible solution over 25 years ago: http://mason.gmu.edu/~rhanson/buyhealth.html

Re: The Greedy Doctor Problem

#32

Post by lotsofpulp »

mattficke wrote: post #24
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.)

The golden days of the doctor “cartel” (and people in the healthcare chain in general) are over.

https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physic...

The 80s/90s/00s were probably the golden years for them, but they got in the political spotlight, and combined with the decreasing proportion of young to old people, the government is going to push down cuts to whoever lacks political power to push back. Such as smaller businesses like independent doctor offices and pharmacies.

The government has already increased supply by letting Nurse Practitioners and Physician Assistants do stuff that doctors used to do, and I suspect a lot more price discrimination is on the way. Expect the average quality of care to fall (may not be a bad thing if overqualified people were treating pink eye), and paying more will result in being seen by someone more qualified.

Re: The Greedy Doctor Problem

#33

Post by zz865 »

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.

Or even better pay nothing and get a government run system that is smart enough to figure out what is important and what is wasteful.

Re: The Greedy Doctor Problem

#35

Post by michaelrpeskin »

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.

That's what I do. It's called "direct primary care". In the last 10 years, I've used two DPC doctors. I loved my first doctor because we had the same philosophies towards health. Last year she started drifting too "mainstream" and I didn't like her style, so I switched and took my money elsewhere. I found a new guy who is really aligned with me and it's been great. It's almost as if having choice and market can work :)

I get the super high-deductible catastrophic with HSA plan from my work, and then I pay $135/mo for my whole family for the DPC doctor (I could pay that $135 with my HSA and have it be on pretax money, but I'd rather invest my HSA pretax right now). The total there is less than any other insurance available to me. If I ever need anything, I just call or email my doc, most of the time we just do a (secure) video chat and I'm done and I don't need to make a trip in. If it is more severe, I can easily get a same-day appointment. He knows me, knows my history, and has an incentive to keep me healthy. The healthier I am, the more I pay him and don't see him.

I love the model!

Re: The Greedy Doctor Problem

#36

Post by teekert »

I think most countries with a civilized, social and sustainable healthcare system do this, right?

Maybe this is the kind of market that can never be free, because you can never step away from a deal, as the alternative is often death. As such perhaps in these matters we should just have some faith in humanity. You know, it works for a lot of open source software. Capitalism is not a silver bullet, people have a consciousness for a reason, use it, have faith in it. You will see that that is the exact thing that will make it flourish.

Btw, all "solutions" would piss me off as a doctor that just wants to help. The vast majority of people deserve and want to be trusted. We work better that way. What a cold piece.

Re: The Greedy Doctor Problem

#38

Post by staticman2 »

evancoop wrote: post #23

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?

Then the doctor fires you for being unhealthy and finds a healthier patient. The patient would have been healthy even if he never went to the doctor and the doctor gets credit and payment for it.

Re: The Greedy Doctor Problem

#40

Post by winternett »

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.

>The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not.

Easy fix... "Just be wealthy!" lol... :|

I've paid for the absolute best insurance I could find this year and gone to doctors my entire life that simply don't care. I've had everything from colonoscopies to MRIs done and I haven't spent more than one day in my entire life in a hospital overnight in over 40 years.

Many would say I'm pretty healthy, but who knows?

It usually seems like doctors peddle as much fear as web MD now in order to drive me through the service bay of fees every time I have an ache or troublesome pain.

If it's any consolation though, my dentist, my auto maintenance shop, my lawyer, and even my local supermarket want a constant revenue stream out of me because they have a pipeline of service that they know they can get a customer hooked on if they coordinate their efforts and make their pricing variable based on being properly opportunistic.

A lot of the tactics the health care industry regularly uses to sell services (and drugs of course too) are from the nefarious book of street drug dealers... In a bad economy, the scams and opportunism are ripe. Getting a second opinion is often VERY EXPENSIVE as well.

Be careful my friends, sometimes it's better to face your fears of "WebMD prescribed" death head-on rather than to bankrupt yourself, because if you don't die, living broke or in extreme debt can be a "silent killer" and harmful mentally and physically to you too. Maybe marry a doctor... That might cut extreme health care costs... By about 5% if you're lucky... :P

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