No Runny Eggs

Late last week a provision of the Stimulus bill managed to break through the dung and was finally seen in the sun light.   The provision calls for the establishment of a Federal Coordinating Council for Comparative Effectiveness Research.  

The Comparative Effectiveness Council is to be established to review medical treatments to ensure that the most effective treatment is being used for the ailment.   Those who support the Council make the argument that it can help eliminate unneccessary treatments for patients thus eliminating costs.   Those opposing it see the Council as being a care rationing group who would not allow life saving treatments for patients that they don’t see as having an economic benefit from the treatment, read that “the elderly.”   This is one of the rare situations where I think both of these arguments are accurate.   I base my conclusion on this article  from the UK Telegraph.

Two years ago, dentists received a new contract under the UK’s nationalized health care.   Prior to the new agreement, dentists were paid much like they are in the US.   They were paid different amounts depending upon the procedure performed.   Crowns and root canals, procedures that are more complex and require extra time, were paid at a higher rate than simpler procedures like standard fillings or simple tooth extractions.

The new contract changed how dentists were paid.   Now, dentists are paid a flat salary and are given targets, that they must achieve, for the number of patients they service.   The result is that there is incredible incentive for dentists to move as quickly as possible through their patient list while treating their ailments.  

The situation with UK dentists sounds an awful lot like the “efficiency” that the new Council is after right?   What could be wrong with that?   A Lot!

Turns out that the number of pulled teeth and dentures sets have risen significantly since the implementation of the new contract.   Why?   Simple!   Because the dentists  get paid no differently for a tooth extraction than they do for a crown, they get paid no differently for a denture than a root canal.   It takes far less time to do a tooth extraction or denture  than a crown or a root canal and, the dentists need to meet with a specific number of patients each day so the shorter the procedure, the more people they see.  

Sounds alot like the dentists are making decisions based on the economic benefit for both them and their patients.   They get paid the same and hey, you can still chew your government provided gruel so what should you as the patient, care whether you get a crown or have your tooth pulled!

I have no doubt that the Federal Coordinating Council for Comparative Effectiveness Research can at the same time reduce costs and provide quality care.   That is, as long as like in the UK, you define “quality care” as being agnostic between a getting a crown and getting your tooth yanked!   That same definition of “quality” will likely not be able to tell the difference between an elderly patient with a heart condition getting a new heart valve or just “making do” because the doctor has other patients to see.

Oh, and for those who think that economic disincentives don’t drive health care rationing, the UK dentists have seen 1.1 Million fewer patients in the two years subsequent to the new contract than they did in the two years prior to the contract.   That looks like rationing to me.   Unless, of course, you think the Brits have suddenly developed a new found love for personal dental hygiene…NOT!