The social-justice question we must pose to physicians is: Are you willing to advocate for changes to the medical system that creates the need for you to take on charity care in the first place?
Patients with dementia need social supports and opportunities and acceptance of their disability in order to feel hopeful despite their functional decline.
Shivan J. Mehta, MD, MBA and David A. Asch, MD, MBA
Outcome-based payment more closely aligns payments with what patients want, which is better health rather than more health care. But these approaches remain challenging to implement.
Measuring outcomes alone is not the answer. There should be a way to reward the doctor for educating a patient about lifestyle modifications and then documenting that the care provided followed patient preferences.
The picture that emerges from study of physician economic behavior is mixed, but from the intensity of responses by some professional societies to Medicare's coding modifier proposal, it appears that economic incentives matter a lot to many of their members.
Many team members such as nurses and medical assistants have key roles in meeting practice goals but receive little if any performance-based compensation. In part, nursing union rules create a barrier by inhibiting trials of productivity-based pay or shared-risk models.
Industrialized nations could benefit from strategies emerging in developing nations such as respectful collaboration between traditional out-of-hospital birthing practices and maternity units in partnering hospitals.
The importance of the Oregon experiment is that the state developed a public process for prioritizing medical services rather than relying on undisclosed private decisions by individuals or insurers.