I am just dubious about the ability of some proposals to inexpensively reduce fatal medical error. (But I am optimistic about others. Checklists seem promising.)
In the present system there aren’t strong economic incentives to reduce medical error. If you consider Checklists to be promising, then the lack of any economic incentives to use their virtues might be part of the reason why they don’t get adopted.
The incentive system of doing procedures that can be billed because they are included in a list of billable procedures and doing them in a defensive way that survives a lawsuit is bad. It means that money is wasted for procedures that cost a lot of money and provide little benefit. It also means that policies such as checklists (if we grant them to work) don’t get incentivised.
The whole system is unable to incentivise cheap solutions. Scott’s post about the inability of a hospital to prescribe Melatonin to it’s patients is illustrative:
This is why the story of Ramelteon scares me so much – not because it’s a bad drug, because it isn’t. But because one of the most basic and useful human hormones got completely excluded from medicine just because it didn’t have a drug company to push it. And the only way it managed to worm its way back in was to have a pharmaceutial company spend a decade and several hundred million dollars to tweak its chemical structure very slightly, patent it, and market it as a hot new drug at a 2000% markup.
The way I would put it is that the credentialism barriers are the immigration barriers.
From a political perspective immigration and credentialism are two different subjects, you have to convince different constituencies to create change.
In the present system there aren’t strong economic incentives to reduce medical error. [etc.]
I think this is broadly correct, certainly in the case of the US medical system.
From a political perspective immigration and credentialism are two different subjects, you have to convince different constituencies to create change.
Yes, from the standpoint of effecting political change, one might have to treat them as two different subjects, even though w.r.t. doctors in the US the two greatly overlap.
In the present system there aren’t strong economic incentives to reduce medical error. If you consider Checklists to be promising, then the lack of any economic incentives to use their virtues might be part of the reason why they don’t get adopted.
The incentive system of doing procedures that can be billed because they are included in a list of billable procedures and doing them in a defensive way that survives a lawsuit is bad. It means that money is wasted for procedures that cost a lot of money and provide little benefit. It also means that policies such as checklists (if we grant them to work) don’t get incentivised.
The whole system is unable to incentivise cheap solutions. Scott’s post about the inability of a hospital to prescribe Melatonin to it’s patients is illustrative:
This is why the story of Ramelteon scares me so much – not because it’s a bad drug, because it isn’t. But because one of the most basic and useful human hormones got completely excluded from medicine just because it didn’t have a drug company to push it. And the only way it managed to worm its way back in was to have a pharmaceutial company spend a decade and several hundred million dollars to tweak its chemical structure very slightly, patent it, and market it as a hot new drug at a 2000% markup.From a political perspective immigration and credentialism are two different subjects, you have to convince different constituencies to create change.
I think this is broadly correct, certainly in the case of the US medical system.
Yes, from the standpoint of effecting political change, one might have to treat them as two different subjects, even though w.r.t. doctors in the US the two greatly overlap.