The gist of Gawande’s article is that sometimes spending more on healthcare actually buys us worse care. And while there are many possible factors for this, one of his arguments is that if we’re going to reform the system in a smart way we’re going to have to change the way we incentivize various services.
For example: if primary or preventive care are crucial, should we reimburse them at higher rates than more specialized fields like cardiology or neurology* orthopedic surgery? Would this be a way to both get more young people into these basic care areas, and also to encourage an emphasis on the “right kind” of healthcare?
In the coming months we’ll talk much more — as a nation, and on this show — about the largest structural questions of the U.S. healthcare system. But we’d like to kick off a series of healthcare conversations by focusing on this tricky, and often personal, intersection of money and medicine.
If you’re a healthcare provider, how much money do you make?
Can you share with us where your income comes from? What percentage is salary, as opposed to fees for service? Do your patients pay out of pocket, or are you reimbursed by insurance companies or Medicare?
Where does your money go, professionally? How much do you spend on malpractice premiums, or advertising, or overhead?
And even if it’s uncomfortable to talk about, how does money affect the decisions you make in terms of care? Or your decision to pursue your particular field in the first place?
- Meredith Baker: Urologist at Bend Urology Associates
- Amanda Clark: Urogynecologist and gynecoogist at Comprehensive Gynecology Associates in Portland
- Chuck Kilo: Internist and CEO of GreenField Health in Portland
- Ronald Turker: Pediatric orthopedic surgeon at Kaiser Permanente in Portland