This is often proposed, but I have trouble understanding it. Real outcomes are not blood pressure or blood sugar numbers; they are deaths, strokes, heart attacks, amputations, hospital-acquired infections and the like.
In today’s medicine-as-manufacturing paradigm, such events are seen as preventable and punishable.
Ironically, the U.S. insurance industry has no trouble recognizing “Acts of God” or “force majeure” as events beyond human control in spheres other than healthcare.
There is too little discussion about patients’ free choice or responsibility. Both in medical malpractice cases and in the healthcare debate, it appears that it is the doctor’s fault if the patient doesn’t get well.
If my diabetic patient doesn’t follow my advice, I must not have tried hard enough, the logic goes, so I should be penalized with a smaller paycheck.
The dark side of such a system is that doctors might cull such patients from their practices in self defense and not accept new ones.
I read about some practices not accepting new patients taking more than three medications. In the example I read, the explanation was not having time for complicated patients, but such a policy would also reduce the number of patients exposing the doctor to the risk of bad outcomes.
A few comparisons illustrate the dilemma of paying for outcomes:
Do firefighters not get paid if the house they’re dousing to the best of their ability still burns down?
Does the detective investigating a homicide not get a paycheck if the crime remains unsolved?
Does the military get less money if we lose a war?
Even if we were to accept and embrace outcomes-based reimbursement in health care, how would we measure outcomes?