November 14, 2012

'Capitated care' misguided effort for health care

Morning Sentinel Staff

In a misguided effort to solve health care funding problems, many politicians and bureaucrats are attempting to pay health care professionals not for the work they do, but for the work they don't do.

Sounds unbelievable? The rationale for this colossally unimaginative plan is that some professionals order too many unnecessary tests, and perform unnecessary procedures in order to get paid more. This drives up health care costs.

Therefore, the idea is to pay professionals a lump sum to treat a certain diagnostic condition. If they use less of the allotted funds, they can keep the extra as profit. If they use more of the funds by doing more treatment, they take a loss.

This model, called "capitated care," generally does not work when you look at quality and benefits to patients. It does help with insurance profits.

The major problem is that the financial incentive is to undertreat patients. Professionals generate profit by doing fewer procedures or less treatment. When there is a question of whether to do a procedure, the incentive is to not do it. Patients stand to lose out.

Fortunately, some professionals will do what they feel is best treatment regardless of finances. They should be recognized and saluted. Ask your own doctor.

The other problematic incentive is for the professional to treat simple cases and avoid difficult, uncooperative patients because they will show less progress and reduce profit.

Ivan Miller, a psychologist who has worked on health care funding for nearly 20 years, has created a far more imaginative, robust and nuanced model. See www.ivanjmiller.com/balanced_choice.html. This model addresses the needs of consumers, professionals and business owners, and could well be integrated into states' plans.

Keith Cook

Licensed psychologist

Waterville

Were you interviewed for this story? If so, please fill out our accuracy form

Send question/comment to the editors




Further Discussion

Here at KJonline.com we value our readers and are committed to growing our community by encouraging you to add to the discussion. To ensure conscientious dialogue we have implemented a strict no-bullying policy. To participate, you must follow our Terms of Use.

Questions about the article? Add them below and we’ll try to answer them or do a follow-up post as soon as we can. Technical problems? Email them to us with an exact description of the problem. Make sure to include:
  • Type of computer or mobile device your are using
  • Exact operating system and browser you are viewing the site on (TIP: You can easily determine your operating system here.)