Here's a Blue-ribbon Idea: Make Patients, Not Physicians, Responsible for Health Outcomes


If current physician-centric healthcare reform efforts don't reduce costs, improve value, eliminate defensive medicine, or produce a better payment model, maybe it's time to shift focus and responsibility from physicians to patients.

In the previous post in this series (“What's the Patient Protection and Affordable Care Act (PPACA) or ObamaCare Going to Do for Us?”), I said that if you want to see the future of healthcare in this country, take a good look at our public education system.

This week’s question is How do we get past some of the “same old, same old” limitations of the various healthcare reform efforts that have been tried before?

National efforts to improve accessibility and both the perceived and technical quality of healthcare in the United States are now more visible. In their article "Health Reform; A Good Year for the Country, A Good Year for the Archives,” Rita F. Redberg, MD, MSc, and Mitchell H. Katz, MD, note that, despite the "bickering, compromise, and arcane parliamentary maneuvering," Congress passed and the President signed PPACA. Nevertheless, say the authors, even this has limitations:

  • It does little to reduce the costs or improve the value of healthcare
  • It touches not the insidious cost issue of defensive practices for want of medical malpractice liability reform
  • Nor does it address the "fundamentally flawed fee-for-service model of our healthcare system" that rewards volume, rather than attributable outcomes (read: quality), cost-benefit, or cost-utility

Another, MAJOR limitation is the "hassle factor," inherent in the insurance model. See the article "Payer Performance Examined" for more on this topic.

Here's a bright and fresh idea, perhaps too logical for the politicians

In an article in JAMA titled “Rights and Responsibilities in Health Care,” the Rand Institute’s Robert H. Brook, MD, ScD, draws a comparison between one's rights and responsibilities when having/using health insurance and when getting repairs done to a car that is under warranty — the key question, he says, is “Did you do the maintenance?” People who want to exercise their privilege to operate a car are required to meet certain standards that help improve outcomes for all participants in the system. The requirements for getting a driver's license are not arbitrary; “they were developed to preserve life and reduce the cost of everyone's insurance.”

Brook says that “Blue ribbons and awards are given to health plans for having high mammogram rates, high colonoscopy rates, and appropriate levels of hemoglobin A1C and low-density lipoprotein cholesterol among their members. Perhaps the awards should be given to patients instead of physicians and health organizations. Perhaps it is time to say to the American public: 'Certain procedures, medications, and preventive care will make a difference in your health, and it is your responsibility, not your physician’s, to take or to do them.’”

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