❔ could value-based care lead to worse outcomes for patients
Value-based care has come up in Packy McCormick’s work a couple times. The value being aligned incentives. If you’re being paid for a healthy delivery, you’ll prioritize the baby and mother’s health. If you’re being paid per procedure, you may prioritize squeezing in as many ultrasounds as you can. The problem is the Kaiser effect.
Let’s say that usually in a high risk birth you, a hospital, charge insurance companies for a significant number of extra ultrasounds and blood tests. Whereas an average birth makes you $X, a high-risk birth makes you $2X. In value-based care, the proposal is that insurance will no longer pay for extra ultrasounds. Now, you make $X for each successful delivery, regardless of riskiness. All of a sudden, you’re disincentivized from ordering those extra ultrasounds because it’s cutting into the hospital’s margins.
Packy suggests in his article The Oscar Puzzle that everyone will eventually want to be Kaiser, but I don’t know if that’s a good thing. I’ve read nothing to suggest that Kaiser is better than any other health insurance company. If anything, I’ve heard anecdotal evidence that they can occasionally put their bottom line above patient health.
What do you think? Will value-based care be a net positive or are there additional changes that need to be made?
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Every post on this blog is a work in progress. Phrasing may be less than ideal, ideas may not yet be fully thought through. Thank you for watching me grow.
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