A version of this op-ed was published on June 18th, 2009 in The New York Times’ Room for Debate blog.
In his recent address to the American Medical Association, President Obama noted that our health care system “rewards the quantity of care rather than the quality of care.” This perverse incentive leads to unnecessary and potentially harmful medicine, while also being a major contributor to spiraling health care costs.
Doctors enter the profession to care for patients, and most are not trained, or have the inclination, to run a business. But our health system’s incentives provide a strong motivation to do just that. In fact, doctors often find themselves in a position where the pressure to generate revenue becomes as important as how they practice medicine, and those who do not pay close attention to the financial bottom line are at a competitive disadvantage. It is no wonder that both physicians and patients are growing disenchanted with the current direction of American health care.
Some health policy analysts entirely blame the medical profession for the role they play in rising health care spending. And indeed, doctors have tremendous influence in the tests being ordered and treatments prescribed. But singling out physicians would be like wholly blaming the players for a proverbial game’s flawed rules. More important than focusing on the players, we need to change the rules.
That means re-aligning incentives to best serve the interests of patients. Physician payments need to be divorced from the volume of care, and associated with evidence-based patient quality measures and a reduction in medical errors.
Furthermore, we need to value the time doctors spend with patients. Instead of being encouraged to squeeze in appointments and rush through office visits, doctors should be incentivized to take the time to counsel and guide, along with improving their communication with patients, not only in person, but over the phone and on the Internet.
Clearly, successful health reform depends on modifying physician behavior. Doing so requires that we change the incentives that motivate doctors.