Fee-for-Service
| Published in Blog
On the Health Care Debate
Following the House vote on health reform, my letter to the editor (addressed to Congressman Peter Roskam) was published in the Wheaton Sun, my hometown newspaper:
Health Care Reform is a Necessity
––––
Fee-for-Service
The necessity to reform the health insurance industry has been central to the larger health care debate for many years. It can hardly be disputed that insurance reform is absolutely crucial to controlling the cost of premiums and granting greater access to coverage. However, too little attention is paid to another root cause of the escalating current health care problem: the fee-for-service payment structure.
I recently heard a terrific series on NPR that brought my attention to this issue. As I understand it, the current fee-for-service system compensates medical professionals on a sort of a la carte basis–that is, they are compensated for the delivery of each of their services, including procedures, visits, etc. Services are priced on a sliding scale, in which fees are more or less based on the perceived technicalities, or skill required by the professional.
Such a system translates to a perception of value that is not always aligned with reality. In other words, more complicated procedures compensate health care providers at higher rates when, in fact, they could require equal time as, say, a counseling session. But counseling or preventative care might ultimately deliver more value to a patient in the long run than a procedure could. This can adversely affect the best interests of patients. Further, it might be argued that health issues are less likely to be addressed at an earlier stage when problems might be prevented, rather than later, once they have progressed to a more serious and expensive stage. Of course, I am describing these possibilities on general terms, and it all really depends on the nature of the problems diagnosed.
The fee-for-service system also encourages health care professionals to consult with as many patients as possible. The effects become problematic when doctors, for instance, spend little time with patients and cannot possibly diagnose or treat each of their patients with the highest quality of care possible. How can health care professionals possibly determine the best diagnoses when we patients have so little access to and time with them? Most of us have experienced very abbreviated, sometimes abrupt, encounters with doctors and specialists. It is no wonder that overall health outcomes are less than satisfactory. And where does all this money go?
It is well known that we Americans spend about twice as much on health care (as a percentage of our GDP) than the average of other industrialized nations, yet our outcomes are worse. A majority of health care professionals argue that the current fee-for-service structure is not the most effective. But where is the issue of fee-for-service in the context of the larger debate? Some of the states have proposed to resolve this issue, and I commend them. However, others argue that we cannot have it all this time around with health care reform. When the experts are expressing agreement that the system is symptomatic of our problems, how can we afford not to?
– Excerpted from personal blog.