I would hesitate to interpret this so naively. For example, there are some vascular surgeons who take on patients that nobody else will touch. These are patients with many bad prognostic risk factors, but they will die without the surgery.
The surgeons who take these patients may end up having terrible stats, but be the most skilled if only because their mortality rate is not pushing 100%.
Comparing this statistic the way people compare gas mileage is a disincentive for these surgeons to operate on patients that need help, but are high risk.
Selection bias (by the physicians) should make that extremely challenging. You could adjust for underlying comorbidities, though that will often not give enough adjustment to make an impartial expert observer feel that it is sufficient.
Some states already do this. For example, for CABG and valve surgery, NY State publishes raw, as well as risk-adjusted mortality rates (RAMR) broken down by surgeon: (warning, PDF) http://www.health.ny.gov/statistics/diseases/cardiovascular/... (begins on pg 21)
Fun fact: Dr. Oz is in there and it even looks like he might be one of the better performing surgeons too. Another fun fact: it can be hard to draw inferences about individual providers this way; check out just how wide some of the the 95% CIs for the RAMRs are, and a lot hinges on how good your risk adjustment model is (details on pg 13).
CMS is actually doing that already (at least for hospitals).
Early next year, CMS will post healthcare quality metrics that it's collected from providers who bill to CMS. In 2015, hospitals will start getting reimbursed based on quality, which is a step in the right direction, however, it is chocked with problems (i.e. treating the best patients will advantage a hospital)
If you were a doctor, would you rather charge more, or less? What keeps you from charging the highest fees in the world? Your reputation. If you're not the best, you cannot charge the most. All of capitalism works this way.
Medical care is not really capitalism. Doctors get about the same reimbursement from any given insurance company no matter how good (or bad) they are, unless they are bad enough to get dropped from the insurance company's panel. Some negotiate for slightly better rates, but that often has more to do with the number of similar specialists in their geographic area on the insurance panel.
Insurance companies consider doctors a commodity. They only place where capitalism really applies is when patients are paying cash.
Source: I'm an MD. My specialties are forensic and child psychiatry. Interestingly, despite severe shortage of child psychiatrists, it is not reimbursed as well as some specialties that have a glut of providers (like cardiology). Not complaining, it's well reimbursed enough for me, but just making another point that it's not really capitalism.
You forgot things like consumers needing information and having a choice. Those need to be present for capitalism to work.
For fun I ask how much it is going to cost when going to my doctor. They refuse to tell me. They can't even make an estimate (tens? hundreds? thousands?) Even after seeing the doctor they can't. I pull out my card and say "I would like to pay now". I get told I have to wait for the bill. It is virtually impossible to find prices. Things are more complicated because the patient is often not the one paying directly due to the "insurance" that goes on.
A few years ago I had a ride to the emergency room. There was only one ambulance company and only one relevant hospital. The morphine in the ambulance was $27. At the hospital it was $129 plus another $75 fee to add it to the drip. Capitalism is not at play there.
According to the site, for the 'Certificate of need', the main arguments seems to be following:
"A number of factors spurred states to require certificates of need in the health care industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an oversaturated field to cover the costs of a diluted patient pool by over-charging, or by convincing patients to accept hospitalization unnecessarily."
I couldn't understand this argument. Something seems to be wrong.
The argument for CON is that if a new facility came in and charged less, then the existing facilities would have to charge more to cover the patients they lost which would adversely affect their remaining patients. So a new facility would need to show the need of non-served patients - ie that they wouldn't take away patients from existing facilities.
It is of course hogwash, but is a nice way for existing facilities to have a monopoly, prevent competition, and not have pricing pressure. Standard rent seeking/corruption that exists in the US.
agreed. How many times have you actually shopped out a procedure by making 10 doctors appointments for checkups and quotes, typically, when they need to operate, you just go with what they say.
Most doctors in rich (i.e. insured patients) hospitals have no idea. My ENT was quite surprised when I told him the charge (>$1000) for his quick look down my throat. And that was only after a lot of shopping around and negotiating on my part. And it didn't include any "treatment" - it was just to look and possibly diagnose.
I'm usually asking the receptionist or other office person - they handle most of the billing stuff, and the other response I sometimes get is "oh, we have to run it through insurance first". They just run a code, and get told what they'll get paid (apparently), not necessarily what my cost/price is.
The system is so fundamentally out of whack, and not at all 'market driven' and yet somehow... my 'free market capitalist conservative republican' friends (I have a few) are really against "socializing" medicine/healthcare. As if, somehow, what we have now in the US is a bastion of free market enterprise.
The cynic in me thinks that the conservative elite really really really enjoy having a dependent class, and ensuring people are at the mercy of private health insurance companies vs the federal or state government helps ensure that dependency in a way they can still control. But... I'm overly cynical, it's late, and my words aren't coming out exactly as I think they should. :/
