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The Greedy Doctor Problem

universalprior.substack.com

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Re: The Greedy Doctor Problem

#71

Post by darkerside »

xondono wrote: post #52

Someone uses “greedy doctor” as an example to talk about an easy to understand version of the Control Problem, and the comments make it into a discussion of healthcare systems. I’m starting to think most readers on HN don’t really read the articles and go straight into the comment section..

They might as well have used abortion as an example. The choice of analogy distracts from the content of the article itself.

Edit: Part of the problem is that the analogy is such an amateur caricature as to be offensive. I am not a doctor.

Re: The Greedy Doctor Problem

#72

Post by Aaargh20318 »

d0gsg0w00f wrote: post #55
cies wrote: post #53

I leaned once that in ancient China they paid family doctors a monthly free, unless someone in the household got sick, then the fee was not paid until everyone was healthy again. Doctors did due diligence on their clients and advised them preventive. They did not want sickly households. Also the incentive is on keeping the whole house in good shape. I learned the opposite once: never let a capitalist near your health…

> I learned the opposite once: never let a capitalist near your health care program. They make money when you are sick, and stop making money when you are healthy. Wouldn't the same rule apply for IT Sysadmins?

The same applies for everyone who charges an hourly rate, they have an incentive to work as slowly as possible.

Re: The Greedy Doctor Problem

#73

Post by SuoDuanDao »

xondono wrote: post #52

Someone uses “greedy doctor” as an example to talk about an easy to understand version of the Control Problem, and the comments make it into a discussion of healthcare systems. I’m starting to think most readers on HN don’t really read the articles and go straight into the comment section..

I noticed that when the 'laws of stupidity' article [1] came up here. I'm very familiar with it as I read it when I was young and impressionable, almost all the comments had nothing to do with the substance of the article.

What makes it more poignant is that I typically go straight to the comments myself, assuming that intelligent commentary on an article will convey what the article was about faster than the article itself. Which would probably be a good assumption - if I was the only member of the commentariate to make it.

[1]http://harmful.cat-v.org/people/basic-laws-of-human-stupidit...

Re: The Greedy Doctor Problem

#74

Post by rectang »

dasudasu wrote: post #61
teekert wrote: post #36

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 consc…

Many countries with universal healthcare still pay by the act. In Canada, doctors are mostly independent service providers that bill the government directly. This can lead to two problems: a) they don’t do a whole lot of medical acts because it already pays so well that they can afford to slack off (e.g., work 3-4 days a week, see very little patients), or b) do a lot of unnecessary acts because it goes directly into…

It's clear why performing unnecessary medical acts is problematic, but what is the issue if doctors being paid by the act work 3-4 days a week? Isn't this just piece work and you can add more doctors?

Re: The Greedy Doctor Problem

#75

Post by jeffrogers »

Maybe start by actually hiring a doctor, a person you can form a relationship with, rather than a health care system/company. The doctor may charge high fees, but their behavior is more likely to be bound by the relationship, and societal expectations around decency and respect between people. This dynamic does not exist between companies (read health care systems) and the people they supposedly serve, but both internal and external corporate incentives -however well meaning or small when considered alone- come together to extract as much money as possible.

Re: The Greedy Doctor Problem

#76

Post by [deleted] »

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.

[deleted]

Re: The Greedy Doctor Problem

#77

Post by ubermonkey »

jeffrogers wrote: post #75

Maybe start by actually hiring a doctor, a person you can form a relationship with, rather than a health care system/company. The doctor may charge high fees, but their behavior is more likely to be bound by the relationship, and societal expectations around decency and respect between people. This dynamic does not exist between companies (read health care systems) and the people they supposedly serve, but both inter…

In the US, this model is usually called "concierge medicine." It sounds weird but it's exactly what you want for a GP relationship IF you can handle the fees ($1-2K annually, and that's going to be out of pocket).

Re: The Greedy Doctor Problem

#79

Post by snegu »

hereme888 wrote: post #47

Or...do something along the lines of what the healthcare world has already come up with: doctors get paid for the quality of care they give, rather than just quantity.

This is exactly what I was waiting to see at the bottom of the article. It's what Medicare is trying to move towards in the US - doctors are paid more if their patients are healthy (as measured by biomarkers, time in hospital, etc.)

Re: The Greedy Doctor Problem

#80

Post by Robotbeat »

lotsofpulp wrote: post #32
mattficke wrote: post #24

Earlier quoted context omitted.

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…

Increasing the supply doesn't mean the average quality of care will fall.

If I pay doctors $400,000 a year to work 80 hours a week and then double the number of doctors and pay them $200,000 a year to work 40 hours per week, the quality of care would almost certainly improve but costs would be constant. And actually, do we pay doctors a premium for those overtime hours where they're actually probably less effective? If so, our costs would go down as quality of care improves.

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