Aetna is working to introduce some market forces into health care. They won’t be paying doctors and hospitals for “never events” – the medical errors that are so bad that they should never happen. Things like operating on the wrong person, or on the wrong knee. David Williams of Health Business Blog sees this as a step in the right direction, and notes that in the free market, businesses don’t get paid when they make mistakes. I agree with him, and would like to see other health insurance carriers following Aetna’s lead. I know that doctors and hospitals don’t want to make mistakes, but I think that a little extra financial incentive might lead to even more safeguards in health care settings to prevent the most egregious mistakes.
But I’m curious as to how this sort of reimbursement change might impact patient care. The way our medical system is currently structured, most health care providers are paid per-patient and per-procedure. If a person goes in for knee surgery and the surgeon operates on the wrong knee, this would qualify as a “never event”. Once the problem is realized, what if other doctors become involved in fixing the situation and operating on the correct knee? Would none of them be paid for their time? What if the patient loses confidence in the surgeon and requests that another surgeon at the hospital perform the second surgery? What safeguards would be in place to assure that the patient still receives top-notch care following the “never event”, given that the care would be provided for free? I suppose that’s where malpractice insurance comes in…
Ideally, we should have enough safeguards in place that “never events” truly never happen. But even if we eliminate the worst errors, there are still a lot of medical errors that could be prevented with extra checks and fail-safe systems in place. As long as we have systems in place to make sure that treatment to fix mistakes – unpaid – is provided with the same diligence as treatment that is being reimbursed, I think that a trend towards not paying for mistakes could go a long way towards reducing the number of preventable medical errors in our hospitals.
I found David Williams’ article in last week’s health wonk review, hosted by The Lucidicus Project.