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The Greedy Doctor Problem

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Re: The Greedy Doctor Problem

#161

Post by ghawk1ns »

maxk42 wrote: post #158

> How can you design a payment scheme for the medical professional so that you actually get the ideal treatment? Draw up a contract whereby you are only obligated to pay the doctor while healthy. The doctor loses money as long as your health is suboptimal and therefore it is in the greedy doctor's best interest to do everything they can to keep you healthy.

Proof of Stake could work here.

Doctor locks up money under contractual obligation. If they act dishonestly and your health declines, they lose their stake.

As long as they act honestly, they are rewarded.

Re: The Greedy Doctor Problem

#162

Post by [deleted] »

poulsbohemian wrote: post #155
gampleman wrote: post #152

Earlier quoted context omitted.

This comment is like saying that Zeno’s paradox is dumb because proud Achilles would never consent to a foot race with a mere turtle - imagine the insult!

Look I understand in making the statement I made that I was hanging myself out there for further critique. My points were simply that: 1) The person doing the work often has limited say in the cost / compensation model unless they are also an owner. 2) Yes, there will always be people who prioritize money over the quality of their services. But reputation has a way of reducing their effectiveness.

[deleted]

Re: The Greedy Doctor Problem

#163

Post by mactavish88 »

maxk42 wrote: post #158

> How can you design a payment scheme for the medical professional so that you actually get the ideal treatment? Draw up a contract whereby you are only obligated to pay the doctor while healthy. The doctor loses money as long as your health is suboptimal and therefore it is in the greedy doctor's best interest to do everything they can to keep you healthy.

I was about to suggest the same solution.

The same approach can be applied to any service that requires regular intervention to avoid service interruption. If you pay someone every time the service is interrupted, then they’ll be incentivized to do a bad job so it gets interrupted more frequently (e.g. contractors tasked with ensuring traffic lights or electricity supply works all year round in all weather conditions).

Pay a flat rate for continual service. Beyond a certain reasonable/acceptable level of interruption, reduce what you pay them. Eventually if they do enough poor quality work they’ll go out of business - as opposed to the current conventional approach that incentivizes them to do poor quality work.

If this applied to certain goods as well (like electronics) we’d probably be able to get rid of planned obsolescence.

Re: The Greedy Doctor Problem

#164

Post by maxk42 »

karpierz wrote: post #160
maxk42 wrote: post #158

> How can you design a payment scheme for the medical professional so that you actually get the ideal treatment? Draw up a contract whereby you are only obligated to pay the doctor while healthy. The doctor loses money as long as your health is suboptimal and therefore it is in the greedy doctor's best interest to do everything they can to keep you healthy.

Or the doctor only takes on healthy patients, and refuses to take on anyone with pre-existing conditions. Also, what happens when people self-select such that only people who often get sick take on these contracts, and people who are normally healthy stick with pay-for-service?

> Or the doctor only takes on healthy patients, and refuses to take on anyone with pre-existing conditions.

Only if they cannot help you. In which case you have the same medical outcome but save your cash.

Re: The Greedy Doctor Problem

#165

Post by mactavish88 »

karpierz wrote: post #160
maxk42 wrote: post #158

> How can you design a payment scheme for the medical professional so that you actually get the ideal treatment? Draw up a contract whereby you are only obligated to pay the doctor while healthy. The doctor loses money as long as your health is suboptimal and therefore it is in the greedy doctor's best interest to do everything they can to keep you healthy.

Or the doctor only takes on healthy patients, and refuses to take on anyone with pre-existing conditions. Also, what happens when people self-select such that only people who often get sick take on these contracts, and people who are normally healthy stick with pay-for-service?

Yes there’ll need to be some way of catering for the reality of untreatable conditions (a kind of force majeure).

Re: The Greedy Doctor Problem

#166

Post by tomxor »

Simple version: Payments is contingent on patient being alive.

It's a life-time contract for the doctor, which aligns the incentives... Provided being in the highly quantized state of "alive" is all we care about, i think this is pretty bulletproof. The only place it will fall down is in the moral grey areas where euthanasia usually enters the ring, in which case a more specific criteria of alive may be necessary to prevent prolonged suffering.

However If this is applied to the multidimensional continuum of "health" it gets tricky again. Verifying you are "alive" can be done by your dog; verifying you are "healthy" would require at least as much independent expertise as the greedy doctor, and is an opinionated subject.

Interestingly though, this is kinda, roughly, sortof how public healthcare is supposed to work: everyone who is alive and in working health is capable of contributing economically and paying taxes... which fund the healthcare system, but since it's so indirect this alignment in incentives can only be appreciated at the organisational level trying to increase efficiency. e.g in theory it should encourage preventative healthcare which minimises long term cost while keeping their income stream alive, literally.

Re: The Greedy Doctor Problem

#168

Post by Sudomac »

It's more a hospital business set up if anything. The hospital admin and shareholders treat their staff terribly and keep most of the actual profits. They end up begrudgingly paying doctors more than the general public but they wouldn't do this if poor - middle class medical students could go to school without signing their financial freedom to the gov. or military.

Re: The Greedy Doctor Problem

#169

Post by Sudomac »

Sudomac wrote: post #168

It's more a hospital business set up if anything. The hospital admin and shareholders treat their staff terribly and keep most of the actual profits. They end up begrudgingly paying doctors more than the general public but they wouldn't do this if poor - middle class medical students could go to school without signing their financial freedom to the gov. or military.

Which is why the hospital owners have recently started convincing lawmakers to allow them to hire as many 'mid levels' they want instead.

They charge the patients the SAME, since, to the eyes of insurance, the services supplied are basically the same. They just get to KEEP more of the difference for the hospital stakeholders with a PA than with someone with a medical degree.

Re: The Greedy Doctor Problem

#170

Post by Sudomac »

Sudomac wrote: post #169
Sudomac wrote: post #168

It's more a hospital business set up if anything. The hospital admin and shareholders treat their staff terribly and keep most of the actual profits. They end up begrudgingly paying doctors more than the general public but they wouldn't do this if poor - middle class medical students could go to school without signing their financial freedom to the gov. or military.

Which is why the hospital owners have recently started convincing lawmakers to allow them to hire as many 'mid levels' they want instead. They charge the patients the SAME, since, to the eyes of insurance, the services supplied are basically the same. They just get to KEEP more of the difference for the hospital stakeholders with a PA than with someone with a medical degree.

Doctors are also basically employees to the eyes of these hospitals. Albeit ones with some skills.

But I think they are abused during their residency and 4 - 5 years of being treated like absolute shit and everyone looking at you like a spoiled idiot (but is actually poor since residency salaries basically cover only housing and food) can turn most futures doctors into jaded and disillusioned cogs for the insurance machine.

Hospitals want to get paid by the insurance companies... so will bend over backwards and make it happen to the employees detriment.

Insurance companies PWN us all. So do not get distracted and think bigger picture. Doctors actually don't know the price of anything, they just do their job, and are getting trickle down from the insurance companies... which the hospitals gut through first.

Yeah, doctors had to work to get paid that much, but its the insurance and hospital business aspect that makes the costs sky high. They have lobbied for it to be this way for decades, letting idiot doctors distract us and have become an easy scapegoat. Most doctors have no idea how they get paid, the hospital complicates it on purpose so that idiots on both the doctor and patient sides are clueless and blame anything but the accurate picture.

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