Monday, September 03, 2007

The Free Choice of Physician Siren

One of the most formidable barriers to health care reform is our dedication to the right of free choice of physician.

Our culture is known for its strong beliefs in individual freedom and human rights. It strikes us as elementary that individual patients should have an unrestricted right to choose the physicians who will provide their care.

Under free choice, my insurance company can hope that my physician utilizes medical resources prudently, the hospital can hope that my physician is disciplined and cooperative, and I can hope to be provided with good care.

But none those things will be assured. For one thing, the obligation of my insurance company to pay whatever physician I choose limits its ability to encourage physicians to utilize supporting services responsibly. For another, the hospital can only get my business through the physician I select and will therefore be more interested in gaining that physician’s favor than in controlling the cost of care and overseeing the quality of medical practice. As for me, my choice is as likely to be influenced by bedside manner or the recommendation of a neighbor as by an informed judgment about the physician’s competence.

In a reformed health care system, physicians would be part of and accountable to an institution such as a hospital or large group practice, which would be responsible for being sure that its physicians practiced in a disciplined, responsible and clinically competent way. As a patient, I would first choose my insurance company based on considerations of cost and the quality of care provided by the health care institutions that it offered. I would then choose my physician from within the institution’s staff.

That sort of system would promote discipline and fix accountability for cost and quality. But it would not include free choice of physician as we know it.

My dictionary reports that in classical mythology, a siren was a sea nymph who lured sailors to their destruction by their seductive singing. Comparing that to being lured into a health care crisis by the idea of free choice of physician is a little bit of a stretch, but it makes the point.

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