On 19.08.2009, at 16:52, Chris Gehlker wrote:

> On Aug 19, 2009, at 5:46 AM, Charles Bennett wrote:
>
>> What is the motivation of the doctor?    He argues that he is  
>> required
>> to take all preventive and rehabilitate measures unless ordered not  
>> to
>> by the patient or person with responsibility.
>
> He could be right.
> My  sister trained in California but now runs a hospital in
> Washington. I think she told  me there is a lot of variation from
> state to state in the amount of discretion that medical personnel can
> exercise in deciding that any given treatment is inappropriate.
>
> I have heard way to many horror stories to doubt that there are cases
> where physicians perform needless procedures to get paid.

Some good grounds for introducing a system where evidence based  
principles are used to decide which treatments under which  
circumstances are paid for by health insurance companies and which are  
not.

For example like they do (or are in the process of implementing) in  
countries with decent health care systems such as eh...

Australia
Germany
UK

etc.

...of course, you need to convince the rabid fringe like eh...



>> I don't know that I want the government making those decisions either

...Chuck...


... that its not the government that makes the decisions, but rather:

an independent group of specialists assesses applications from groups  
of medical professionials to get particular treatments for particular  
conditions under particular circumstances "encoded" for inclusion in  
the reimbursement system according to evidence from clinical trials  
that the treatment is efficacious and better, or at least as good  as  
(and no more expensive than) the current gold standard.

Its the way forward, unless you think that it makes more sense for  
patients, or their freinds and families, or their private insurers to  
have the power to wave money at hospitals, or private practitioners to  
obtain the treatment that they in their ultra confident naivety are  
sure is appropriate.

mark.
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