Thursday, September 03, 2009

A Suggestion on Rationing

Long-time friend Peter Kilborn submitted the following comment in response to my posting about the Massachusetts proposal to abandon fee-for-service as the way of paying for health services in favor of “global” payments; i.e., capitation.

“Capitation immediately raises the fear of increased rationing. If the provider gets only a fixed sum to treat me, it will want to limit what I receive. I believe that is exactly opposite the present system, where the incentive is to provide more. But I have no thoughts on how to reconcile the two regimes.”

Here is my suggestion:

I would consolidate my local hospital (in my case, South Shore Hospital in South Weymouth, MA) and its medical staff into a single entity and give it the capitation payment for me. South Shore Hospital is a non-profit organization operated under the control of a board of trustees consisting of my friends and neighbors. I would hold the board responsible for overseeing a system of care that continually tried to find the “right” balance point between cost and care – “right” being in the eyes of the beholders, in this case the good burghers of the Boston South Shore.

I would also want an alternative possibility that I could drive to within an hour or so in case I felt that my local provider was not managing well.

There has always been rationing and always will be. A line has always been drawn by doctors and their patients at the point where further testing or treatment is thought to be not “worth it.” It now becomes clear that things are structured in such a way as to inflate the perceived benefits of further testing and treatment while obscuring the perception of cost.

The question is, can things be structured differently so as to create a better balance? I believe they can. Personally, I am not enthused about having government making the determination of what is “right.”. I don’t want it done by insurance companies, either. I have more confidence in my fellow citizens who make up the board of my local non-profit provider institution.

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