I work in the country's largest single payer medical system. It's called the Veterans Administration. The physicians are employed at a fixed salary, with no bonus, so I don't get paid more if I do 1 procedure or 10.
But I STILL order tons of unnecessary tests. Why? It's not because I get paid more! It's because I am scared of getting sued.
What WILL massively cut costs is doing what New Zealand does, and basically ending the medical malpractice scam that only exists to enrich trial lawyers, whom are a far more insidious lobby than doctors ever will be.
95% of patient injuries have nothing to do with true "malpractice." A doctor cannot promise a good outcome 100% of the time, just like a programmer cannot generate bug-free code 100% of the time.
Instead of the current system, make it so that an injured patient is entitled to compensation from a national "patient injury fund."
The ambulance chasers make zero dollars, doctors don't have to waste money on "defensive medicine," and injured patients get prompt and fair compensation.
And if a physician has too many such episodes, then they can be referred to the licensing board.
Malpractice premiums are not correlated to malpractice claim payouts. Period. 2000-2006, the amount collected in premiums rose 120%, while over the same time frame the amount paid out to claims decreased 14%.
"Defensive medicine" is non-reality-based, head-up-ass flat-out expensive crap, and you should stop practicing it and start questioning why your malpractice provider charges what it does.
> Malpractice premiums are not correlated to malpractice claim payouts.
And neither is correlated to overall healthcare costs. Malpractice limitations are something those who are interested in preventing health security because they want to maintain insecurity in the working class to keep labor costs down use as a distraction from real problems in the health care system.
Not sure why you point as far as NZ when Texas basically eliminated it by capping pain and suffering awards at $250,000.
Medical malpractice insurance (which is the tort system manifested as a cost to doctors) is not the most expensive part of healthcare though so your point is not really correct.
His point was that worrying about malpractice causes doctors to spend more money on tests and other diagnostics than they normally would so that they don't have to worry about being sued.
Correct. That's the thing to discuss I think. And the suggested solution of national "patient injury fund." seems like the best solution candidate proposed so far. Thanks
Malpractice claims are generally paid out by a small percentage of the medical provider population. Maybe if you guys policed yourselves better, malpractice would become almost non-existant:
I know a resident who was sued because his signature was the only one on the call list the lawyer could read. He didn't treat the patient, he hardly interacted with him at all, but he was still sued.
As much I detest ambulance chasers, it is ultimately juries of uninformed laymen who decide the malpractice cases. If the ambulance chasers stopped winning, they would stop sucking money out of the system.
Why would a layman jury (all of whom are not doctors and are patients) every choose the side of the doctor ?
Wouldn't it make a lot more sense to have those juries staffed with medical practitioners only ? How is such a jury a "jury of peers", as guaranteed by the constitution ?
Thinking about it for a long time, yes, I would actually want such a trial to be decided by people who have been in the same situation as the cop. I am sure that they are decent enough people that if there is actual abuse they would vote to convict.
Of course it'd have to be police officers from far away, who ideally do not know anything about the case other than is presented in the trial.
That would be more fair than taking random people, who will represent the mob a lot better than they'll represent police officers.
The fear that one will be sued and possibly lose their license is one that factors into the way many physicians practice, and at the end of the day, the patient's suffer both financially and physically.
For example, appendicitis is largely a clinical diagnosis, meaning that a diagnosis can be made solely on the patient's presenting symptoms and lab values, and subsequently rushed to the OR for surgery. A CT scan is not necessary, and should be used if the patient's presentation is not a typical one. However, at many hospitals, CT scans are performed as part of the routine work-up. CT scans can cost $1500 a pop, and the radiation received from one is at least 10 times the dose you'd get from an x-ray, which increases your risk for cancer.
In 2007, there were 68 million CT scans performed. We perform 5 scans for every 1 in France [1]. We perform the most MRI scans, which range anywhere from $2k to $5k [2][3]. Do you think we're on the whole healthier than those in France? I would hazard a guess and say that we aren't. In fact, with the amount of radiation we're giving our patients, we're likely hurting them quite a bit. Japan, our rivals for the gold medal in imaging volume, recently conducted a study that showed that 3.2 percent of cancer cases were caused by imaging radiation [4].
And I'm talking about just one largely unnecessary test performed to diagnose one condition. You can imagine the bigger, sadder picture.
Many, many physicians don't even think twice about the amount of radiation they're giving to their patients, or how much they're costing the system, or the incentives they're giving companies who are a part of this chain of inflation to continue to sell scanners and charge exorbitant amounts. They order the tests because they don't want a lawsuit at the expense of patients' health and pockets. I don't necessarily blame them. Out of the thousands of patients a doctor sees, all it takes is one minor slip-up to drag them into a legal battle that may very well tarnish their record, cost millions of dollars, and result in losing their license.
But I STILL order tons of unnecessary tests. Why? It's not because I get paid more! It's because I am scared of getting sued.
What WILL massively cut costs is doing what New Zealand does, and basically ending the medical malpractice scam that only exists to enrich trial lawyers, whom are a far more insidious lobby than doctors ever will be.
95% of patient injuries have nothing to do with true "malpractice." A doctor cannot promise a good outcome 100% of the time, just like a programmer cannot generate bug-free code 100% of the time.
Instead of the current system, make it so that an injured patient is entitled to compensation from a national "patient injury fund."
The ambulance chasers make zero dollars, doctors don't have to waste money on "defensive medicine," and injured patients get prompt and fair compensation.
And if a physician has too many such episodes, then they can be referred to the licensing board.