Dr. Costello’s “Best of Health” Quarterly · Vol. II, No. 1 · Spring, 1991
Health Care Players’ Motives
As every Perry Mason episode reiterates, find the motive behind human action and you find the truth.
When you hear someone discussing quality in Medicine, it is wise to ask who is discussing the issue and what is their motive for being in the health care field. A summary of the major players in health care is shown at right.
Only four players have an interest in quality, the patient, the doctor, the employers and the hospitals.
The patients have the only “pure” interest in quality. After reading the other article in this bulletin one should be more educated as to what should be looked for when defining the “quality of medicine.”
The physicians have the next strongest desire for quality. Physicians want quality because 1) good results make for happy patients and referrals; 2) bad results make for unhappy patients and no referrals; 3) good results are intellectually and emotionally fulfilling; 4) providing the latest treatment is the best psychological defense against the futility of treatment when the patient dies.
Three things can deteriorate the physicians desire for quality: 1) inadequate pay for services; 2) patients that are impolite, unreasonable or dishonest; and 3) malpractice accusations and/or dishonest Review Boards.
The employers want quality for several reasons. They want their employees’ health care insurance benefits to satisfy their employees and insure their employees’ continued ability to work. Employers look on employees as assets that they want to maintain. Employers lose their enthusiasm for quality when health insurance premiums cut into company profit.
The hospitals want quality because good results for patients using their services is good for business. Hospitals are not interested in quality when it cuts into their profits. There will be no interest in quality by hospitals when they no longer can make a profit.
There are four players not interested in quality. Their motive for being in the health care field is either to make money or control people by controlling monies.
The first is the insurance companies. Their goal is to make money by insuring the most people with the least medical risk and, when pressed, to pay out the least monies for medical claims. They have no interest in quality and seek to maximize the shareholders return on investment. They will not even touch the area of medical quality of care for fear that they would become liable in malpractice suits.
The second is the pharmaceutical companies. They are strictly in the health care field for the money.When there is no more financial reward to drive research and development of drugs for humans, there will be no more new drugs.
The third is the universities. They have no interest in quality. They seek only funds, as government grants, as benefactors’ gifts and through special contracts with the insurance companies. They have no interest in quality as their patient populations are usually captured by location, by cost of new therapies and by therapeutic restrictions on the surrounding community. They seek control by determining practice guidelines of the more dangerous kind, as described in the accompanying article. They seek control by determining who gets what residency programs, hospital beds and ancillary services.
The fourth is the government. The government is in health care strictly for control, financial and social. Financial control by the collection of taxes and then by maldistribution of monies when patients need medical service. This group is the most dangerous to your health because it does not keep in touch with scientific, economic or financial realities. Government has no interest in quality. An example of this was the refusal by Medicare to pay for routine mammograms. Fortunately, this finally was changed effective January 1, 1991, three years after studies confirmed the benefit of routine mammograms.
At the present time, the group of players least interested in quality in medicine are the ones deciding the fate of medical care in America. The motives for government, insurance companies and universities being in medicine are not in the patient’s best interests. Government and insurance companies should not be deciding the future of health care for America.
The best player to decide what medical care should be is the patient. The people should choose by national referendum. Physicians should be advising the patients on this issue as we do for illness.
Thank you for reading this article all the way through. It is our hope that you, the patient, will ask yourself two questions when discussing the quality of medicine: “Who do you want deciding the quality of medical care you will receive?” and “What are the motives of the person, company or agency discussing/ deciding these issues?”