GIF89a̙fffff33333!,I8ͻ`(dihlp,tmx|pH,Ȥrl:ШtJZجvzxL.zn|N~@8V8 a%(T@  bĆJhȱcGnXH20dĉDTp2Lqi@I,*D$̣.Qit!|*4QB^TP@.jD FIBLmĺUHBک8jv&ֹC[C[v* $5zG[kpc<[W{.)HWњ> Jmםi!L/ V5&s mjdO ʓh(л˅"ݥ!Ye% QS 2xĀ{,4aUb$$'Ԅh\t C}enpc!z%g"E,=!IE% 85 gSS9VtS7UDԌSquImyC ȇ{]6g 1*l\3tfYۭPCXxOB=>RcP0Xפ^'9t]*\]O ,$1ex}{m9` :s[kfMhfL/'mmsQ){ PV@GQ.Ap[ws,:% oq^ f8!!|AE&Ƒx:ǿd)0 <]g:٭!PD۔z䁾du% FXv HDE%^xaULkF䈧 ix#c22L#ǶaF??T! :#{A!MPcJ>*rk$b١~:" ƞy/dF(HPNJ,SDK\eiL&ʯ ⢣0uD fy@i:N>#!xKeS@Y4,shyl6g&IRT,S πiAFz0ldP2iQxdk֣aw}O dW&}`GO̯ڔDYD {G"פW&)~w_T3A|_ΰv>Vmo{Q^{~|I:cFDa~Ok+D(y<ͨU/D m-,ؗi5"'vb#noҀ  &#7a(6؁ "8$X&x(*,؂.0284X6x8:<؃>@B8DXFxHJp6p00P(pSx^(U\(^XaQ؆ 0rZx`^hH=pȇ}Xp pH"`؈0i8px(`((؈g(Xx[؋V8~NxxxhfHH`xfHhx8X#؍"pe(Ũ ؈0˘XxqobvX昏:Hن)YI!iH&*#و'yh647lXؑs3)6)hF ؆<[M%ЈM\Kۚ ّ=f ]Cz9:0vXݜ <x+Aܾ,-? ڵ-:ߺm>=-]^Pι=ކKiн=a|}%omͬ\}MdMވ͝؋X|۬>n 1ۼߝ:C=xIĽ2( KN]D-Q-T>\l3,:ʪ ͈zm7+iI@ʚ=ms]\F N$톍౎ A^*$>W~(~n,ݞN|띭'!Rm>{=6@~X؍ˎ@ڶ՜ +©̎ŽH" pWmΉN ϑ=5(m︭⯞㘻Nϔu@~_=n>ۍo\OI~亮D-kI4 `ޮ'|+Т`-+9_1);ɲ.\Mi_}/,+)b1|Ժ:M}WH|_?*ƋǍ>m隖/yw?nv* SӦ_'UȌ-Wyc{ޏ# /Sdž*˯/U f&_5@ INYR}:6qԺ".q``shP>: {N? 0 *Ԣ 78KQ0ACVk 1;"Bh"1̏(A(r4Dɯ[rdQ̚oBb)ѡ(o''2qчNLL(۠.\Ql,Ϝ <(O<LgEHb*4\Q`)DosV0U^etawTbZH6ZijsRtjlUT;-JaD#hs=3ZST^>Mw= |?WWlZ}V Wށ8a?9dG&dOF9eWfe_9fgfo9gwg:h&hF:ifi:jj:kk;l&lF;mfm߆;n离n;oox'xG>ygy矇>z駧z>{{?|'|G?}g}߇?~秿~?`8@ЀD`@6Ё`%8A VЂ`5Av(0 $"$@@(B@ @ &< BЃP@81ЁbBD"BD* 07V;TA*E,cи hшM<D3N'v3:t#S%‐Cǒ)RrDr1͑!XI@VQȣK"҉A$!p3~MDDv24m#YfRԘ8g8w~-.QMRG)Ѕ ?SCbPhyKG5XcP I.$pAI7B&3Ae$,EVke!L+6-3@Z-}0+TA8i(3ظ46e+c!63Pb@%ZZlD;ϴ"(%#)Y.+)8gdyT"#QEj 1߸MҀ$EyY $f9UG/nLmiMs=x}d _R%;̡u7[qKevmkdʒ:fiΙOΖh`m5=4yl2(@>$$%kbav~,=JчEu[m2oWߑerOg|Nh7S;us[5x q-j|3tі)r~y}[d#%Qƣ6v?>9ͩzm^<.Δ:ͫtO9oAӛX~ziF}~ܙ޷:7;s.y1v:vz$Gi'z3oUu y'Qݸ j?>ͯg}y_COϙ⛞_~@oG ZjOlyk'Ĩӿ3Y-c@#k:;{@D#[=Ż@_A2A?18C>9R83LӴփ7+)ۺKKq#B=J"@9$%\t!/8BBк/$@8A1-ϻ71ԂC l:,@@6t>k>*8,ړ맢BBH۩LӲJC0 $yK695 C#@Ck6B;I~*3N0F~:*,HBԵ#d/L;4EL*$lt9>$dEm>AD>WdU26ƛk<|GRܤbBo$@I@ GLJ%FC|ES0)):/iCoy\0CI|=w,I:s5W򥉫!lVşܙ2cJ& pJ*X9Yȧ<Z jİc8 G QT_;&k%Bh$BKCdozsCAƍ!qDǿ4\DADBry!ċGDȫ R˛K:2̉Qj0Œ~J4*Z&RIpL̏ 0͌۲dNB2̽5T-M@A#ܜ@HrMT<C#:[-+ν:NKW#ALLl&+PMDTPL̻9:$OF,DzO&-JS O 8ǤIѾf#>J# , 'M;"e3'<p*όPSZ/EC\UD*}EP[P8mQnPěBtS[m2XiVGq ˬM!L$@V]%H 'vC]ҖDЀeTA=Y#3T#Wye0(}-P|6.mS'MXdY&eMZ:0|%,yRZE"*Z#dNZژų$mIXE@Dm(8;YBK[O3S*uCGY`F&`ۼہfIdm#luB[l[T+\@QR$\[|ۇ5Eř)/Sݱ]Rr%U5b݈֕U%]kN]U\*YE:1K8%^٥ŞFpMQ$SPp]WAU_ *_z0BE_&6FVfv `‚_`C`=,EY!J{ݶ\LC ̚]¥PKX9VdŋeRJٱS1ӫIf ε+Ël LDmE#;؄j!$cݤUUM`7<6c,cqx$*3?K3^KO@. / I~G#E~hp t deLJݨv1K1h&GiR,vឭ\)3r,.⠤VUSbB";ElCc4FӰ:m&nE4ޮWmc>Lǫi T{Y0Qdv\L:BX.B=Xf\,*Eh/E\lo~, dTZ.FqjL..BDŽLklmײiMXiudR'SrRvXKaoŇk";e WUk˽r*vJQo*K޺>j-Jԋ%beFDM@(T̝b8Ϟqad$Q1n ĝї>"&n*\'\[eO#[VyNcH^y}<0/vzNfvUg=T ^R) NrVgbS%8C;_^sOUl%ORiK?TxaGuM&)-Z ˾V'zXtumO(> [HO*s&K2fWe+oVtBrIoovPz.VTOV5[ˣfs"~rfog3#mz{s->,p_%/VĔMj-u{2 婗ժOgeXI[dYJKaΨ++,@^B[F_@[`B^O% 'hhJ# Mœ ٭$ WT,)-Ei*ȳ١0ͩ`$qq`rr/H+pyh=z*\fB$R< 4җ"A(7x&#L^ `@Z E0lo&q@Р4zqG"ǒóL,KkPcTb^(KZW;Lx5MTyԔW3+~~MDYvIk5%bM-m ,͏%j\IM&\8퉊ZO^JVc":L@tn:Hc3 0 pF: Tkn08̱r̫(Kh"`A4h.+:4gyWC4 g_ШUĠ#[_}$a~<_HA]gbK{!WhWPgݍEb4rߎFj,JatɜW#{0E;\D$j t%Ywya -0\Xdz/963N>9qډ(7]Y7dYmhMlyjt*pW|#%諆nmXX!;Ԓ֧)~AhyİjaxrDh8Ydm**!81j)L##ZçWnhH,jZ[(*`)+畳{q5AO 8DEK ;,ԹA !&l*{šq O$|A ",BpO紤\hHDK9Iclء>]c1joq6mfku ν$M6yҦ"Gi'5;N"ۏK>9[~9kNy{9衋>:饋ҹ驫:뭻:(>;~;˞;;<<<;<1o[=={0?>>髿>>?????(< 2| #( R 3 r C(&!(!F<"%P2N|"()RV"-r^"(1f<#Ө5n|#(9ұv#=~# )A/;
Sunday, October 20th 2013

Fee For Service And More Care

On anecdote all physicians claim, and perhaps believe, they provide services irregardless of its impact on their own financial bottom line. And likely on anecdote all physicians will, sincerely, claim the same for most of their colleagues. And so it’s always controversial to claim that physicians provide more care, of marginal or no necessity, based on their own financial gain. But here we are again with evidence for such. A paper from the NBER concludes that California obstetricians are performing c-sections in part motivated by billing.

[P]hysicians are almost 10 percent less likely to receive a C-section, with only a quarter of this effect attributable to differential sorting of patients to hospitals or obstetricians. Financial incentives have a large effect on C-section probabilities for non-physicians

This follows oft forgotten research which has consistently shown that financial interests motivate some surgical procedures. Indeed a two decade old NBER paper implied c-sections were being driven by decreasing child birth. For instance, when the reimbursement for coronary artery bypass graft surgery went down, the number of surgeries performed went up. Many other papers have concluded the same.

Deincentivizing procedures and more healthcare are difficult things. Shifting some of the reward away from volume has been attempted with capitation and basing some reimbursement on things other than volume i.e. pay for performance but as long as there remains substantial reward for doing more it is difficult to imagine doing less healthcare.

Share/Bookmark