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The Greedy Doctor Problem

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Re: The Greedy Doctor Problem

#171

Post by chriscross »

R0b0t1 wrote: post #89
oaktrout wrote: post #22

Earlier quoted context omitted.

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?

I know you're framing it as patient choice, but it would incentivize doctors to actually want to research new solutions instead of give stale advice that doesn't seem to work.

Do you really think that doctors don't keep up on education? All doctors are required to do continuing education every year to keep up to date on the latest advances. Most I know go to national conferences to learn more about their speciality. Then you have the portion of doctors that conduct research and actively advance medicine. Most doctors I know (anecdotal, I know) are constantly striving to do more, to learn more because they care. Doctors know how much responsibility they have to help people and even save lives.

Re: The Greedy Doctor Problem

#172

Post by R0b0t1 »

chriscross wrote: post #171
R0b0t1 wrote: post #89

Earlier quoted context omitted.

I know you're framing it as patient choice, but it would incentivize doctors to actually want to research new solutions instead of give stale advice that doesn't seem to work.

Do you really think that doctors don't keep up on education? All doctors are required to do continuing education every year to keep up to date on the latest advances. Most I know go to national conferences to learn more about their speciality. Then you have the portion of doctors that conduct research and actively advance medicine. Most doctors I know (anecdotal, I know) are constantly striving to do more, to learn m…

> Do you really think that doctors don't keep up on education?

No, I know they don't.

Re: The Greedy Doctor Problem

#173

Post by teekert »

dang wrote: post #126
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…

Please don't take HN threads into generic flamewar, and please particularly keep off the nationalistic flamebait track. We detached this subthread from https://news.ycombinator.com/item?id=29270645 .

I apologize.

Re: The Greedy Doctor Problem

#174

Post by jvvw »

dasudasu wrote: post #98
goopthink wrote: post #85

The article proposes prepayment options. Why not go to the "other, other obvious" solution, which is results-based payments? In healthcare, that's value-based care. In other industries w/ agent-principle problems, it's called "taking on risk". You're incentivizing results and outcomes, rather than whatever specific actions lead up to those results. It means that the focus is no longer on the activity provided by the…

Then doctors filter what patients they take to guarantee these good outcomes. This is already done by some surgeons. Surgery is already a subset of medicine heavily judged on outcomes.

I got the impression that the same phenomenon was present with driving instructors and driving test pass rates. If it's clear after a dozen or so lessons that they might not pass then say that you will stop teaching and suggest a different instructor.

Re: The Greedy Doctor Problem

#175

Post by hereme888 »

snegu wrote: post #79
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.)

Right. And many insurance companies already reward hospitals and doctors more if the diagnosis methods and treatments were appropriately effective. For example, if the patient with pneumonia is discharged but re-admitted a week later for recurrence of the pneumonia because they weren't given the appropriate antibiotic, or their bed during hospital stay wasn't at a 30-degree angle, etc...then they get less money from insurance.

Or if a particular emergency department physicians keep ordering unnecessary and expensive diagnostic tests, not only may those tests not be reimbursed, but their "score" for quality of care goes down, and so will their personal reimbursement.

Re: The Greedy Doctor Problem

#176

Post by oaktrout »

R0b0t1 wrote: post #89
oaktrout wrote: post #22

Earlier quoted context omitted.

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?

I know you're framing it as patient choice, but it would incentivize doctors to actually want to research new solutions instead of give stale advice that doesn't seem to work.

The advice works if patients listen (which is patient choice). Reducing salt intake and losing weight are simple ways to lower blood pressure and they are also effective.

Re: The Greedy Doctor Problem

#177

Post by vanviegen »

dahfizz wrote: post #123
vanviegen wrote: post #120

Earlier quoted context omitted.

> You can't just say "add more doctors" as if that helps anything. Why wouldn't it? There are more than enough people who would want to become a doctor, and would be capable. Especially if the work/life balance would be better. At least in my part of the world, it seems that the system is rigged to keep the number of docters artificially low.

> Why wouldn't it? I explained in my comment: There is a shortage of doctors. Unless you know 50,000 people with medical degrees searching for a job, you are going to have to fix the situation that created the shortage rather than just wishing more doctors would appear. This is what dasudasu was doing. They identified a cause of the shortage (doctors are encouraged to work 60% of a work week) and your response was "s…

No, what I said is that there appears to be a structural problem causing a lack of docters, which we need to fix, as it causes high work pressure (and rather high earnings). I don't think doctors working 60+ hour weeks is the type of solution to the shortage we should aim work.

Re: The Greedy Doctor Problem

#178

Post by edanm »

poulsbohemian wrote: post #140

>The medical professional is greedy, i.e. they want to charge you as much money as possible, and they do not (per se) care about your health. They only care about your health as far as they can get money from you. I'm not even going to read the rest of the article because the premise up front is so flawed. It assumes that doctors alone have say over pricing / compensation, and that's just not reality. It's much like…

It's not that you're wrong, it's that what you write only addresses the title of and first sentences of the article, rather than anything the article is actually trying to say.

This article is about game-theoretical-ideas of how to deal with the principal-agent problem. The "greedy doctor" idea is just a motivating example. You're seemingly taking offense at a knowingly fictional setup. That's akin to not wanting to learn how to solve physics problems about objects in a world where friction is assumed away, because that's not realistic. Umm, what?

Re: The Greedy Doctor Problem

#179

Post by jl2718 »

The answer is probably from a different area of computer science/game theory: consensus.

This has been practiced by patients for a long time by asking for a second opinion. However, this no longer works, because doctors now all share your medical record, and the second doctor risks getting sued if they disagree, while they bear no risk at all for agreement with the first doctor.

So, the consensus rules have to actively break the model for collusion. I’m not sure how to do this, and actually I think this is a relatively unexamined area of game theory, because most models assume tautological correctness of consensus.

Breaking consensus requires an oracle, which is by definition, a source of truth that operates outside of the consensus model, and cannot be affected by participants. This would be something like a piece of diagnostic equipment that can’t be altered or censored. It also requires a very large incentive for correctly predicting the oracle result against the consensus opinion.

So here is a straw man mechanism: 1. Assume condition can be assessed by a diagnostic test oracle 2. See many doctors, solicit opinions on treatment 3. For each proposed treatment, the doctors bet on the post-treatment test result 4. Choose the treatment with the best most money wagered on a good result 5. Add your service payment to the pool 6. Undergo treatment, take post-treatment diagnostic test 7. Distribute all money to the correct predictors

Re: The Greedy Doctor Problem

#180

Post by dTal »

efitz wrote: post #109

The ways to address this problem are “usual and customary[ed- autocorrect] prices”, consumer ratings, information transparency, externalities such as courts to punish fraud and malpractice, and skin in the game. I have thought about this a lot in the context of real estate- up to recently, agents typically got a fixed commission (generally 3% each for buyer and seller in the places I’ve lived). There is a moral hazar…

>If they’re helping me buy a house, and they get a percentage, then it’s in their interest for me to overpay. If I’m selling a house, then the margin for increasing the sale price above market value is probably not worth the effort

Wait. Surely for the realtor these two scenarios are identical? Every purchase is also a sale. The only difference is in what role you've cast yourself.

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