Like any small business, physicians need enough incoming revenue to keep practicing. That’s why monetary incentive is so strong:
The way cancer doctors are paid may influence the choice of drugs they use in chemotherapy, a study published yesterday has concluded.Payment methods do not seem to affect whether doctors favor chemotherapy over other treatments, the study’s authors said. But once they decide to use chemotherapy, the current payment system appears to prompt some doctors to use more expensive drugs, the study found.
“Providers who were more generously reimbursed,” the authors wrote, “prescribed more costly chemotherapy regimens to metastatic breast, colorectal and lung cancer patients.” The study, by researchers from the University of Michigan and Harvard University, is published in the current issue of the academic journal Health Affairs.
Physicians need enough revenue to stay in business and continue treating patients. Sad to say, but money talks.
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{ 4 comments }
Sad to say money talks…..!? It should be a crime!
Doctors are motivated by money?!?! Perish the thought! Money is only something valued by lawyers, physicians are only interested in getting sustenance wages.
No money, no mission.
Even Mother Theresa had a budget. Even in poor countries hospice care isn’t free.
If physicians cannot be counted upon to respond to monetary incentives then how will they ever be induced to show fiscal restraint. Was the failure of the HMO model as it was envisioned decades ago a failure of economic incentives for physicians to be effective? Not at all; it was that incentives were effective that patients rebelled against the HMO model.
The study adds to the survey by Dr. Neil Love, entitled “Patterns of Care.” One of the results of this survey shows that for first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists (who do not derive personal profit from infusion chemotherapy) prescribed an oral dose drug (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug docetaxel.
In contrast, among the community-based oncologists (who do derive personal profit from infusion chemotherapy), only 18% prescribed the oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29% prescribed the expensive, highly remunerative drug docetaxel.
While the Michigan/Harvard study showed results before the new Medicare reform, the Patterns of Care study showed results that the Medicare reforms are still not working. It is still an impossible conflict of interest.
And the existence of this profit motive in drug selection has been one of the major factors working against the individualization of cancer chemotherapy based on testing the cancer biology.
Two scientific studies giving us a dose of reality. Once a decision to give chemotherapy is taken, oncologists receiving more-generous Medicare reimbursements used more-costly treatment regimens.
Sources:
http://content.healthaffairs.org/cgi/content/abstract/25/2/437
http://patternsofcare.com/2005/1/editor.htm
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