In praise of global capitation

It may be time for insurance companies to throw in the towel and let doctors ration care.

From the Boston Globe (Overuse of stents in heart cases reported)

A new study gives fresh evidence that many people with clogged heart arteries are being overtreated with stents, and that a simple blood-flow test might help prevent unnecessary care.

Fewer deaths, heart attacks, and repeat procedures occurred when doctors implanted fewer of these tiny artery props, using the blood-flow test to decide when they were truly needed, the study found.

Results were published in today’s New England Journal of Medicine.

We really don’t need to read NEJM to learn that cardiac procedures are overutilized. We just need to understand how lucrative these procedures are to the doctors and hospitals that perform them.

There’s a pretty simple solution to this problem: introduce global capitation. Put the primary care physician –or even their cardiologist, if appropriate– in charge of managing all the expenses for a patient. Overutilization will drop dramatically. Outcomes may even improve. As an added benefit, reducing overall utilization for health care services will also ameliorate physician shortages and hospital overcrowding.

Physicians should be rated on outcomes achieved and patient experience in order to help patients make the right decisions about whom to sign up with. Insurance companies can curtail their involvement in medical practice and (almost) everyone will be better off.

January 15, 2009

One thought on “In praise of global capitation”

  1. Global capitation will fail, as it did once before in the 90’s, unless and until tort reform is addressed. Doctors can’t “control” what treatments patients get as long as patients continue to demand certain services — with the ever-present threat of a lawsuit, if those demands aren’t met and there is anything that could possibly be construed as an adverse outcome. Given the latitude taken by (note: not “given to”) the lawyers, this could easily include “pain and suffering for not getting what they want.”

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