Foreigners are in the top tier:
But this cash cow for the Israeli health care system may be in jeopardy.
…[M]any worry that the lure of foreign money is creating a two-tiered medical system, where hospitals shift the best doctors and facilities to the high-paying customers and lessen service to Israelis. (USA Today)
Linda Gorman explained the problem of pay-for-performance with teachers: because of the small number of students per teacher, average student test scores can be more influenced by outside-the class-room size than by what the teachers are doing. As a result, a P4P scheme can end up rewarding bad teachers and penalizing good ones.
Austin Frakt has identified an additional problem in rewarding Accountable Care Organizations for their performance. In order to get around the small sample size problem, ACOs have to have at least 5,000 patients. But the larger the number of patients, the more physicians that are needed. And if gains are shared equally (rather than apportioned on the basis of marginal product) the larger the number of doctors, the less incentive anyone of them has to meet group goals.
“The doctors were considering giving my mother coronary artery bypass grafts plus the two valve replacement surgeries she’d rejected when she had a far better chance of surviving open-heart surgery in decent shape. My mother seems to be heading down the greased chute toward a series of ‘Hail Mary’ surgeries — risky, painful, dangerous and harrowing, each one increasing the chance that her death, when it came, would take place in intensive care.
“The cost to Medicare would probably have been in the $80,000 to $150,000 range, with higher payments if things had not gone well. More than a third of Medicare patients have surgery in their last year of life, nearly a 10th have surgery in the last month of life, and a fifth die in intensive care.”
Scott Burns reviews Knocking on Heaven’s Door by Katy Butler.
There are 2.6 million elderly New Yorkers who receive Medicare, the public health insurance program for the elderly. But one in three patients — nearly 900,000 — are enrolled in Advantage, Medicare HMOs run by private insurers.
Dr. Jonathan Leibowitz, who serves 30 patients under Medicare Advantage at his Brooklyn practice, said he was blindsided by UnitedHealthcare’s decision to give him the boot.
“A patient can’t see his doctor? What are they doing!” he asked.
UnitedHealthcare told Leibowitz that because of “significant changes and pressures in the health-care environment,” he’d be getting the ax on Jan. 1.
From the New York Post.
Checking up on a doctor is becoming a major snag for ObamaCare shoppers in California. Three weeks into open enrollment, the state’s insurance exchange, Covered California, has pulled its online directory of medical providers after acknowledging there are serious problems with the information. The California Medical Assn. says it found mistakes such as obstetricians labeled as ophthalmologists and the wrong doctors described as fluent in Russian and Farsi. Anthem Blue Cross, the state’s largest for-profit health insurer, has shut down a similar physician search tool on its website until it can be updated for new plans for sale now under the federal healthcare law. And consumers say calling other insurers and doctor’s offices around the state often yields confusing or conflicting answers, leaving them largely in the dark. (LA Times)