Money-driven Medicine: a big part of the problem.

For-profit corporations are legally and ethically obligated to first deliver value to their shareholders. That obligation has enormous implications for the delivery, evaluation, and reimbursement of health care services.
The impact of this situation was brought home in the film version of Maggie Mahar’s book “Money-Drive Medicine”; I attended a screening of the documentary last week in NYC.
I wasn’t sure what to expect; there have been quite a few films on health care, reform, insurance and related topics recently, but none that defined the fundamental problem as clearly and cogently as MDM. Care is fragmented and disorganized, with patients not treated as humans but as discrete and separate body systems; in the film the care appears coldly mechanistic. Physicians’ narrow focus on their specialty is part of the problem; this isn’t to blame the docs entirely but rather to illustrate how the entire reimbursement process has bastardized health care.
With docs narrowly focused on body systems they ignore issues that affect other systems. Their very deep but quite narrow knowledge seems to stop at the outer layer of the heart tissue for cardiologists or the fluid surrounding the eye for opthalmologists. Of course the body isn’t a collection of ‘systems’ operating independently but a marvelously interconnected and interdependent whole.
Kind of like the health care system.
Maggie’s film doesn’t offer a solution. Instead it reminds us that the health care system is just that. If reform is to work, it must consider the impact of change on the entire ‘body’.
At the top of the list is thinking through the motivations of the players. For profit insurers and health care companies are in business to make profits for their owners. That isn’t necessarily a bad thing. But it does mean patient care is of secondary importance. While insurers and hospital chains and Investors may yell ‘foul’, their charter requires them to work for their owners and to claim they have reordered their priorities isn’t credible.
This isn’t meant to infer that not for profit entities are entirely different; as the CEO of a regional hospital told me years ago; “no margin no mission”.