市场的特质 -- 卓越无法被复制:
(1) islands of excellence spring up in a sea of mediocrity and they tend to be distributed randomly—they're not correlated with anything; (2) they almost always exist because of the effort, ingenuity, enthusiasm, energy, and vision of a few people involved in actual production, and almost never are the result of anything that's happening on the demand side of the market; and (3) (most importantly) they tend not to have any objective characteristics that anyone else can copy.
三个检定好医疗市场异质性的研究：
A study of high-performing hospital regions (by researchers connected to the Brookings Institution) was unable to find any characteristics that could be replicated in a straightforward manner. Some had doctors on staff and paid them a salary. Some paid fee-for-service. Some had electronic medical records. Some did not. (See previous posts here, here, here.)
Another study, reported at the Health Affairs Blog, looked at 12 multispecialty group practices including such high-performing practices as the Cleveland Clinic, the Geisinger Clinic, the Intermountain Medical Group, the Mayo Clinic and the Virginia Mason Clinic. Of those practices, only two employed physicians directly and the other ten paid fee-for-service. Conclusion: salary without supplements or consideration for volume is the exception rather than the rule. We also learned that, driven by competition to recruit doctors, most of our multispecialty group practices compensate at levels that approximate or nearly approximate what the physicians could earn in private practice. As one of our participants told us: "Simply paying all physicians in the US on a salary basis will not be a panacea for our current [financial] ills
A third study by the Commonwealth Fund examined five high-performing health plans. The only commonalities researchers could find were subjective and qualitative (e.g., "forging and maintaining a strong relationship with physicians," plus that same idea expressed three or four different ways). Not the sort of things you can put in an operations manual and refer to as "marching orders."
Goodman提出的economic approach(见doctors as engineers)：
Start paying more to the islands of excellence that are higher performers. Start paying less to the low performers. Eventually, stop dealing with the low performers altogether. Encourage every doctor, every hospital administrator and every other provider to come forward and propose different ways of being paid. As long as quality doesn't suffer, be prepared to pay 50 cents for every dollar the provider saves Medicare.
Finally, search for ways to empower patients — give them control over their own health care dollars and give providers the freedom to repackage and reprice their services in patient-pleasing ways in order to compete for patients and their dollars.
但是，Atul Gawande explained how medicine should be practiced: (此君是哈佛PH教授，ObamaCare推动者之一)
This can no longer be a profession of craftsmen individually brewing plans for whatever patient comes through the door. We have to be more like engineers building a mechanism whose parts actually fit together, whose workings are ever more finely tuned and tweaked for ever better performance in providing aid and comfort to human beings.
Source: http://feedproxy.google.com/~r/TheJohnGoodmanHealthBlog/~3/NL-7Pf4tVq0/
