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

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.