In the bmj US Editor’s Choice this week, ‘Physician pay must change’, Edward Davies quotes Steven A Schroeder, chair of The National Commission on Physician Payment Reform and professor of health and healthcare at the University of California, San Francisco as saying, “We’re now at a point where the level of spending on healthcare is unsustainable, and the way that doctors are paid is one of the single most important drivers of our escalating healthcare costs.” He’s talking about the way doctors’ decisions in the US are fuelled by a fee-for-service payment system which rewards action, not outcome and ‘encourages doctors to provide more and more costly care, regardless of benefit to patients’. (doi:10.1136/bmj.f1540).
‘Once again it serves as an example in the BMJ’s campaign against Too Much Medicine (www.bmj.com/too-much-medicine). Right at the heart of the current system is a direct incentive to overdiagnose and overtreat—doctors’ livelihoods depend on it.’ says Davies.
While the UK has a different healthcare system, such a culture of dependence on screening is likely to have the potential to adversely influence the debate on screening issues in this country, ignoring lack of effectiveness and substantial harms (see earlier posts, risks around DCIS and the latest New England Journal of Medicine article, ‘Risk of Ischemic heart disease in Women after Radiotherapy for Breast Cancer’, Sarah C Darby et al, March 14 – for numbers of women who will die prematurely from radiation-induced MI – and that’s only one of the harms).
See: Edward Davies, US News and Features Editor: Physician pay must change. US Editor’s Choice, BMJ 2013;346:f1684 – http://www.bmj.com/content/346/bmj.f1540