In the case of the car body shop, individuals who drive inexpensive cars carefully can end up saving money. Under universal insurance coverage, or post-ACA US coverage people can't be charged differently based on their health status. This means the benefits of prevention are now more muted for individuals. This is especially true with people moving to publicly-funded Medicare post 65 in the US. Of course this is a good thing if we want protection against un-preventable disease or accidents, but harder for the preventable component of chronic disease. Perhaps a system which addresses chronic illness needs through different tracks, i.e. you've chosen lifestyle interventions with low payments or you haven't with accompanying higher costs. Somehow we need stronger ability for individuals to reap the benefits of preventive choices.
Thanks for your insight. Ask 100 body shop and auto mechanics, how many would feel responsible for how people drive? They get paid to fix the car. Kaiser differs in making more money if people don’t use the health care system. So their incentive would be to reduce health care use but that’s not the same as promoting health. But that’s a whole another story. E.g. Palliative care would be very profitable but not necessarily “health-promoting.” Unfortunately, in a sci-fi world, individual people would have to be responsible for their weight, blood pressure and HbA1C (diabetes measure), subjecting themselves to regular testing and receive payment for improvements and penalties for worsening. Isolated from the immediate consequence, they face only long-term effects at which time they find themselves in the body shop. Too late for driving lessons.
I can’t speak for all doctors but as a proceduralist, I’m like the body shop mechanic. I fix the damage. The mechanic doesn’t give driving lessons, make laws on DOI or generate car safety policy. Likewise, health as a measure of the “healthcare” system would be like measuring your mechanic based on how many accidents occur. The two share a world but represents a misunderstanding.
I like your point about many health problems being long-term ones that depend on our interaction with our environment (stress, nutrition, exercise, and so on). But you call these "patient choice", whereas I would imagine there's a significant environmental component that isn't necessarily a patient's choice. I'm wondering if you think we can have policies and design choices that nudge people to make better choices for their long-term health, before they even need to see a doctor?
In the case of the car body shop, individuals who drive inexpensive cars carefully can end up saving money. Under universal insurance coverage, or post-ACA US coverage people can't be charged differently based on their health status. This means the benefits of prevention are now more muted for individuals. This is especially true with people moving to publicly-funded Medicare post 65 in the US. Of course this is a good thing if we want protection against un-preventable disease or accidents, but harder for the preventable component of chronic disease. Perhaps a system which addresses chronic illness needs through different tracks, i.e. you've chosen lifestyle interventions with low payments or you haven't with accompanying higher costs. Somehow we need stronger ability for individuals to reap the benefits of preventive choices.
Thanks for your insight. Ask 100 body shop and auto mechanics, how many would feel responsible for how people drive? They get paid to fix the car. Kaiser differs in making more money if people don’t use the health care system. So their incentive would be to reduce health care use but that’s not the same as promoting health. But that’s a whole another story. E.g. Palliative care would be very profitable but not necessarily “health-promoting.” Unfortunately, in a sci-fi world, individual people would have to be responsible for their weight, blood pressure and HbA1C (diabetes measure), subjecting themselves to regular testing and receive payment for improvements and penalties for worsening. Isolated from the immediate consequence, they face only long-term effects at which time they find themselves in the body shop. Too late for driving lessons.
I can’t speak for all doctors but as a proceduralist, I’m like the body shop mechanic. I fix the damage. The mechanic doesn’t give driving lessons, make laws on DOI or generate car safety policy. Likewise, health as a measure of the “healthcare” system would be like measuring your mechanic based on how many accidents occur. The two share a world but represents a misunderstanding.
I like your point about many health problems being long-term ones that depend on our interaction with our environment (stress, nutrition, exercise, and so on). But you call these "patient choice", whereas I would imagine there's a significant environmental component that isn't necessarily a patient's choice. I'm wondering if you think we can have policies and design choices that nudge people to make better choices for their long-term health, before they even need to see a doctor?