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Here is a great post from a physician who asks the very valid question: Why don’t we pay more for better service in the healthcare? 

Whether defined by more experienced physicians, better bedside manner, or increased time spent trying to figure out exactly what’s wrong, better quality doesn’t affect the bottom line in a medical practice – physicians get paid the same even though they’re acting different.  This poses a natural barrier to incentive which doesn’t favor improved care in the U.S.

The solution isn’t simple though.  In a system that already lacks for enough to go around (money AND physicians), how do you pay better physicians more and still subsidize those in need…

How we pay physicians creates problems.  We have a totally irrational payment structure, which discourages thinking and encourages doing.  We have a payment structure which drives physicians towards speed and away from careful consideration.

Unless we recognize the importance of the payment system and revamp that system, we will continue to get what we pay for – quick, incomplete visits – too many procedures – unwillingness of physicians to communicate with emails and phone calls.  And just remember not to blame the physicians.  They are making economically rational decisions.  If you design payment as Medicare has, you will reap the weak seeds that you have sown.