Standardizing healthcare

Opinion: Amount of experience carried by a medical proffessional irrelevent in pay schemes, only time spent on a category of a patient irrelevant of the experience.
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How Government Killed the Medical Profession

Reason ^ | Apr. 22, 2013 | Jeffrey A. Singer

As health care gets more bureaucratic, will doctors go Galt?
I am a general surgeon with more than three decades in private clinical practice. And I am fed up. Since the late 1970s, I have witnessed remarkable technological revolutions in medicine, from CT scans to robot-assisted surgery. But I have also watched as medicine slowly evolved into the domain of technicians, bookkeepers, and clerks.
Government interventions over the past four decades have yielded a cascade of perverse incentives, bureaucratic diktats, and economic pressures that together are forcing doctors to sacrifice their independent professional medical judgment, and their integrity. The consequence is clear: Many doctors from my generation are exiting the field. Others are seeing their private practices threatened with bankruptcy, or are giving up their autonomy for the life of a shift-working hospital employee. Governments and hospital administrators hold all the power, while doctors—and worse still, patients—hold none.
The Coding Revolution
At first, the decay was subtle. In the 1980s, Medicare imposed price controls upon physicians who treated anyone over 65. Any provider wishing to get compensated was required to use International Statistical Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes to describe the service when submitting a bill. The designers of these systems believed that standardized classifications would lead to more accurate adjudication of Medicare claims.
What it actually did was force doctors to wedge their patients and their services into predetermined, ill-fitting categories. This approach resembled the command-and-control models used in the Soviet bloc and the People’s Republic of China, models that were already failing spectacularly by the end of the 1980s.
Before long, these codes were attached to a fee schedule based upon the amount of time a medical professional had to devote to each patient, a concept perilously close to another Marxist relic: the labor theory of value. Named the Resource-Based Relative Value System (RBRVS), each procedure code was assigned a specific value, by a panel of experts, based supposedly upon the amount of time and labor it required. It didn’t matter if an operation was being performed by a renowned surgical expert—perhaps the inventor of the procedure—or by a doctor just out of residency doing the operation for the first time. They both got paid the same.

http://reason.com/archives/2013/04/22/how-government-killed-the-medical-profes

 

In the 90's when HMO and PPO's were gaining popularity, I told physicians then that one day health insurance companies were going to dictate how they were going to practice medicine. Physicians should have gotten together and stopped them from doing this but they didn't and this is why you are in the situation you are in today.

 

Well considering most medicine is very high end "mechanical repairs" on humans not unlike what a master automotive tech or veterinarian can do having to justify costs makes sense, someone has to say NO to medical costs at some point. In some countries they have a one-payer system with medical provider education heavily paid for by the government to keep costs down with various means but doctors have more leeway to practice medicine in return for say lower salaries. In the US insurers and the government through its programs set controls on prices this in turn often takes away medical liberty to known treatments.

Japan does this the fixed the cost of every procedure a doctor must charge a suturing of a wound might be one small cost if this size and a higher cost if this size but the rates compared to the US are low. In Taiwan they did a hybrid system of care but if you see a doctor to much a government person talks to you and explains that is not good unless they find the care medically needed at that level.

By the way did you people as healers enter medicine to make money or save lives and ease suffering? My grandfather was a surgeon and he made a living comparable to a upper end middle class worker in an example a union master electrician he expected to live nicely but his passion was to heal and help the sick. The making a living part was getting a decent income and job security how many doctors can't get work even now in the US if qualified and they do good work - 0. Hell the government could collapse and society fall apart and a doctor would be a hot asset to have assuring good treatment.

 

works the same way in canada, procedures have fixed price tags attached...MD's like it because the government pays them and pays them well no insurance companies to fight with for treatment approval ......