Answered Essay: How do current insurnce incentive systems affect physicians’ and patients’ decisions?

How do current insurnce incentive systems affect physicians’ and patients’ decisions?

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When management uses financial incentives to stimulate   efficiency, it places   on the individual   physician the responsibility for both the patient’s clinical interests and the organization’s financial solvency. This is a dual mandate: treat the patient properly, but do so within budget so that the organization can prosper. In this way, physicians become agents of management in meeting its goals; this role may conflict with physicians’ traditional role as patient advocate. A physician acting purely as a patient advocate would ignore all organizational and personal influences (including   costs) to determine   the best clinical decision for individual patients.   Thus, although   incentives (in both   managed   and   traditional   fee for service   care)   theoretically sustain physicians’ freedom to make individual clinical decisions, in reality, they may divide physicians’ loyalties, subliminally or otherwise. Ironically, some economists may view managers’ use of incentives ultimately as a decision made on behalf of patients to keep premiums competitive .

In contrast to incentives, which require that a physician make a decision about the cost and quality of every possible intervention, rules establish a framework for decision making. Only for those patients perceived to fall outside the guidelines must a physician weigh the costs and benefits of challenging the rules or providing the additional unit of care.

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