I recently watched the movie Money Driven Medicine. The movie documents many of the current ills of the American healthcare system. The movie’s focus details how financial incentives drive both the quantity and quality of care. Any health economist will of course say ‘duh’, but for those who believe that medicine is purely an altruistic endeavor, this may be an eye opening film. Some of the problems they document include:
- Doctors get paid to provide more services whether or not these services actually benefit the patient.
- Doctors get paid for procedures. Thus, procedure focused specialists get paid much more than primary care physicians.
- Many doctors coming out of medical school that prefer to focus on primary care won’t do so because they are saddled with debt from their training.
- According to the Dartmouth Atlas, regions that spend more on health care don’t have healthier residents.
- America has the best specialized care, but likely not the best care overall. The U.S. does not rank highly in the prevalence of preventable illness.
- Hospitals don’t advertise to patients, but instead advertise to attract doctors. When doctors have admitting privileges, they bring their well-insured customers as well.
- Quality is suffering. Despite this, politicians (especially Republicans) consistently claim that America has the best healthcare system in the world. These politicians also receive significant funds from lobbyists who want to maintain the status quo.
- The film claims that there is an inherent conflict between doctors (who are supposed to put patients first) and corporations (who are supposed to maximize profits). In reality, however, doctors and corporations both care profits and both care about patient care. Believing the corporations don’t care about patient health at all or that doctors don’t care about profits at all is naive.
One thing I found interesting, was that primary care doctors complained that they weren’t paid enough, but they also complained that they had short visits with patients. Of course, these primary care docs choose to have shorter visits in order to make more money.
Another interesting point the film makes is that European use government-run insurance systems to to ensure high quality care for all its citizens. Then, this say person says the following: “After Medicare was passed in 1965, elderly patients were getting far more care than they were getting before then. And that’s when our industrial medical complex I would say took off.”
Overall, if you read this blog regularly, you won’t find anything new in the film. Further, the film does not offer many solutions to the problems it presents. The one solution it offers is to have patients more involved in the decisionmaking process. The true benefit of increase patient decisionmaking is dependent on the physician presenting the treatment choices honestly and in a thorough manner. Financial incentives likely skew how the doctor will present these options.
Although it does not present any revolutionary material, if you want a film does a good job of explaining some of the many problems facing America’s healthcare system, Money Driven Medicine is worth a watch.