Incentives for Doctors for giving Vaccines?

[Ygrene Imref]

Correlation does not equal causation, and there is no evidence supporting that. I'm not getting into how there are several things that are incorrect in the above.


If someone is chronically ill, the things in the incentives program wouldn't keep them ill. It would reverse it (as best it could).

That would be a good thing for the patient.

I'm not seeing the bad side, other than it being "suspicious".

Because you think the first part is ridiculous, you cant even fathom why an insurance company would want chronically ill patients, how that fits in with the incentive program, and how it overall means more profits for the insurance company. And, it is much more than correlation; I was purposefully pithy because most in this thread have not even reconciled the issue of the OP. It would be a distraction if I actually put up research and evidence of my statement - if I do, I will make another thread.

I was hoping to get to that by this point in the thread, but I am having too much trouble getting people to admit that a doctor accepting side money for doing something they are already salaried to do is ethically questionable, let alone wrong.



The focus is on the doctors, and why they would take money to do something they are paid to do, and/or the made an oath to do. The insurance company is a PROP for the ethical ambiguity (or downright unethical decisions) of the OP.

It is not about the insurance companies.

If the straw men for the ethics of insurance companies keeps coming up, you can count me out of a discussion. I don't debate because I find it to be disingenuous: you don't have to agree with that you are debating. Let's continue to focus on the ethical implications of the DOCTORS taking money from insurance companies. The intent was not to debate the ethics if insurers.

 

[Non sequitur]

Because you think the first part is ridiculous, you cant even fathom why an insurance company would want chronically ill patients, how that fits in with the incentive program, and how it overall means more profits for the insurance company. And, it is much more than correlation; I was purposefully pithy because most in this thread have not even reconciled the issue of the OP. It would be a distraction if I actually put up research and evidence of my statement - if I do, I will make another thread.

I was hoping to get to that by this point in the thread, but I am having too much trouble getting people to admit that a doctor accepting side money for doing something they are already salaried to do is ethically questionable, let alone wrong.

The focus is on the doctors, and why they would take money to do something they are paid to do, and/or the made an oath to do. The insurance company is a PROP for the ethical ambiguity (or downright unethical decisions) of the OP.

It is not about the insurance companies.

If the straw men for the ethics of insurance companies keeps coming up, you can count me out of a discussion. I don't debate because I find it to be disingenuous: you don't have to agree with that you are debating. Let's continue to focus on the ethical implications of the DOCTORS taking money from insurance companies. The intent was not to debate the ethics if insurers.

I understand what you are saying, I just don't see (as it is) as bad nor agree with the logic behind it.

 

[Ygrene Imref]

I understand what you are saying, I just don't see (as it is) as bad nor agree with the logic behind it.

Well, that's fine. We can respectfully agree to disagree.

 

[Non sequitur]

Well, that's fine. We can respectfully agree to disagree.

Agreed!

 

[ananda]

You are saying you can't give me an example of what naturalistic treatment would be for what condition is... because you might be killed?

What kind of tests and why did you trust them?

This is all beyond the purpose of this thread. I will merely state that - in my direct experience - I do not hold allopathy in high regard especially since such practitioners - as the OP points out - often hold divided allegiances.

 

[Non sequitur]

This is all beyond the purpose of this thread. I will merely state that - in my direct experience - I do not hold allopathy in high regard especially since such practitioners - as the OP points out - often hold divided allegiances.

Since Cigna, Great Western, Blue Cross/Blue Shield, and United Health Care cover some naturopathic medicine, should we put them in the same distrust?

 

[Ygrene Imref]

Since Cigna, Great Western, Blue Cross/Blue Shield, and United Health Care cover some naturopathic medicine, should we put them in the same distrust?

I personally find companies having a hand in homeopathy, or holistic medicine problematic also. Take cannabis, for example: there have been several cases in the States, and around the world that have shown cannabis (from smoke/vaping/edibles/oil) stops the symptoms of epilepsy in their tracks. This works with pets too.

Cannabis also has several dozen scores of health benefits - in its raw form, as an activated oil, or even through smoking/vaping/etc. Companies like the aforementioned will want to genetically modify cannabis, or isolate what they believe is the only active chemical needed for a specific purpose. (This alludes to my critique on companies not wanting "too healthy" of a customer.)

So, in that sense, I would never actually trust a Ayurvedic, holistic, homeopathic or "natural" alternative from those companies. In fact, there is a popular cancer center that boasts natural/homeopathic/ayurvedic healing as a natural alternative to a technological/academic medical treatment (like blasting the body with radiation.) Since academia had an attitude of disdain and ridicule to those types of medicine, I wouldn't be convinced they aren't jumping on the bandwagon to hook people that are infatuated by the "natural" movement, but are too socially "plugged in," and/or trust academic medicine "also." No doubt, insurance and pharmaceutical companies will cut its potency, and dope it with stabilizers needed when they isolate the stuff for their own profitable gains. It will be all about profits, not health.

This is already happening with cannabis, but it hasn't picked up much ground because (surprisingly,) the public is taking a stand against anything other than cannabis that grows as it does naturally - especially cannabis that has not had gene sequences doped in order to handle pesticides, fungal and bacterial attack.

 

[ananda]

Since Cigna, Great Western, Blue Cross/Blue Shield, and United Health Care cover some naturopathic medicine, should we put them in the same distrust?

I do. If they need to walk hand-in-hand with the force of government at their side, then I have reasons to distrust.

 

[bhsmte]

This is all beyond the purpose of this thread. I will merely state that - in my direct experience - I do not hold allopathy in high regard especially since such practitioners - as the OP points out - often hold divided allegiances.

Beyond the purpose of the thread? You talk constantly about not trusting medical science, so I am curious what kinds of tests you had to confirm you had cardiovascular disease, etc.. And, you would need specific diagnostic tests to confirm cardiovascular disease, because there are many conditions that mimic the symptoms of cardiovascular disease, when a person has no cardiovascular disease.

 

[ananda]

Beyond the purpose of the thread? You talk constantly about not trusting medical science ...

No, I spoke of not trusting patentable, drug-focused symptom management of allopathy, and their conflicts of interests regarding sources of income and political schemes. I did not say I don't trust real medical science.

 

[comana]

I do not see this as a problem, nor do I see how it can be a scheme to keep patients chronically ill to increase insurance profits. (That last part makes no sense to me at all)

The specific BCBS incentive plan linked earlier by the OP has stipulations for payment eligibility that would likely result in few actual incentive payments being issued. One of the major requirements that the member be enrolled in the eligible insurance plan for the entire calendar year in which the date of service for the exam/vaccines happens. This is beyond the control of the provider.

The way I see this program it does not violate any ethics between patient care and provider. Rather, it falls in line with most bonus incentive programs an employee might be offered as a part of their employment package. My experience is that most employee performance based bonus programs are also realistically unattainable by design but serve as a way to lure employees in a competitive hiring environment. A large offering of contracted network providers to insurance members makes an insurance plan more desirable to members. Incentive plans to providers encourage contracting with said insurance companies.

Back to the ethical dilemma of provider performance based incentive payments. This is not a problem ethically. The providers are eligible for these payments from insurance companies because they are meeting goals that increase preventive health standards that lead to better health outcomes for patients and thus lower claim payments from insurance. It does not imply that these providers were not already meeting or exceeding these standards or that they are only providing a higher level of care because of the incentives. Rather it is a financial reward (or kickback) for fewer healthcare claim payments due to preventable illnesses.

It just makes sense and good business for an insurance company.

 

[bhsmte]

No, I spoke of not trusting patentable, drug-focused symptom management of allopathy, and their conflicts of interests regarding sources of income and political schemes. I did not say I don't trust real medical science.

Ok. So which diagnostic tests did you have to determine cardiovascular disease? Also, who interpreted these tests for you?

 

[comana]

Where I come from doctors usually own their own practice and are paid per procedure - not salary. Is it different in the US?

Most private practice providers in the US will be paid on a fee-for-service basis. Therefore the argument that insurance companies will incentivize providers to do specific preventive procedures as a means of increasing insurance profits is an odd one. Fact is that insurance pays provider claims on a per procedure basis that also meet medical necessity criteria. There is no gain to insurance companies to incentivize providers to add procedures (which I assume the OP believes are not medically necessary or beneficial to the patient) to claims that insurance is contracted to pay.

However, incentivizing good preventive medicine will ultimately keep claim payments lower with early intervention of any potential medical conditions. Insurance profits obviously increase with a healthy insured member population versus a member population that mostly consists of patients needing constant care and insurance payouts.

 

[ananda]

Ok. So which diagnostic tests did you have to determine cardiovascular disease? Also, who interpreted these tests for you?

I do not divulge such personal information on public boards.

 

[Ygrene Imref]

Most private practice providers in the US will be paid on a fee-for-service basis. Therefore the argument that insurance companies will incentivize providers to do specific preventive procedures as a means of increasing insurance profits is an odd one. Fact is that insurance pays provider claims on a per procedure basis that also meet medical necessity criteria. There is no gain to insurance companies to incentivize providers to add procedures (which I assume the OP believes are not medically necessary or beneficial to the patient) to claims that insurance is contracted to pay.

However, incentivizing good preventive medicine will ultimately keep claim payments lower with early intervention of any potential medical conditions. Insurance profits obviously increase with a healthy insured member population versus a member population that mostly consists of patients needing constant care and insurance payouts.

What percentage of healthy people on insurance do you think would maximize profits for insurance companies? We know it isn't 1 (=100%,) and the argument I think we both agree on is that the answer isn't 0 (=0%, or marginal) either. Moreover, we know insurance companies are doing it to make a profit - not because they care. I am curious as to what you think that percentage would be - and the ethical and sociological implications of the existence of said percentage.

And, there is a way to analytically find this number that maximizes profits, so the answer isn't negligible - and it is used by the companies to do exactly what I am asking. If you want to give me your opinion on a more "precise" and accurate figure using this way, that would be fine too - just let me know the parameters you used.

Or, I can do that too, and we could even compare. It may be clear, perhaps, that I don't agree with you at all - in any capacity - but, lets see if we can discuss this from a purely objective direction (i.e. math.) Then, let's use those numbers and qualify their implications.

 

[bhsmte]

I do not divulge such personal information on public boards.

You don't have to divulge the results, I only asked which diagnostic tests, that you stated you received. But hey, it's cool if you don't want to answer.

 

[DogmaHunter]

$400/10 vaccine childhood combo 10 per eligible member.

Page 15.

http://cognitivetruths.com/wp-content/uploads/2017/05/2016-BCN-BCBSM-Incentive-Program-Booklet.pdf

I don't think it is limited to vaccines; there is an itemized incentive plan for multiple procedures and consultations.

Regardless of how the funding works or what incentives exist or not...

I'll just say plain and clearly that if you refuse to vaccinate your children, you are an irresponsible parent. I'ld even go so far as to say that depending on the context, you should even be eligable to be convicted for child abuse in some cases.

You are exposing your children to unecessary and irresponsible risks, akin to letting them play with hunting knives and loaded guns.

 

[DogmaHunter]

Of course they don't get $400 flat out or it would be illegal; the perpetuity of incentives for recommending procedures and actions that would ultimately be profitable for insurance companies is the issue.

Why do doctors need incentives to act on behalf of insurance companies? Even more, why would a doctor take money to do things s/he is already receiving a salary for?

Both are good questions.

But I think you leave out the best, and most important, question.

That question is:
Why are private insurances even part of this equation in the first place???


After all, health is not a luxury product. Why would you want the coverage of your medical bills be in the hands of a private organization of which, ultimately, the ONLY purpose is making money, which by extension thus has, as a logical result of its business model, an interest in NOT paying your bills?

It would be like me getting extra money for assigning certain problem sets, and exams that don't necessarily benefit the student - despite my job description and salary to do this. It is an ethical issue.

I agree there is an ethical issue here. But I think we will disagree on its exact nature.
The ethical issue in my opinion, is that your health is not a luxury product and that private for-profit insurance organizations have no business sticking their nose in that.

They act merely as a "third party" that actively try to get a piece of the pie, while they contribute NOTHING to the health business. Except perhaps, a lot of misery for a great many people.

And, page 15 clearly says doctors get paid $400/Combo 10 - for every eligible candidate. You don't see anything wrong, or conflicting with your doctor recommending a procedure that will gain them extra income?

I see a lot wrong with the overall structure behind it. The thing you are complaining about is but a symtom of that larger problem.

You are focussing on the pixel and missing the bigger picture.

 

[DogmaHunter]

So, the implication here is why a doctor that makes a salary would choose to perform procedures that allow them to make a kickback from an insurance company - insurance companies that dont care about the wellbeing of the patient at all.

Insurance companies idd don't "care" about the wellbeing of patients. They care about profits and finding excuses for not having to pay medical bills.

However, did it ever occur to you that they have incentives for doctors to engage in preventive treatment so they can save money later by not having to pay for expensive procedures, which have been prevented by preventive treatments?

Paying the doctor 400 bucks could, in other words, save them 10.000 bucks further down the line.

In that sense, the patients benefit from this practice.

Having said that, and as I made clear previously already, I stay of the opinion that private for-profit insurance companies have no business sticking their nose in health care practices.

It only ever leads to misery, higher prices, high waiting times,...

When it comes to health care, private insurance is most definatly not the way to go as the primary model.

 

[DogmaHunter]

I see this instead: "Encouraging less-than-optimal health provides a steady stream of income and dependence, and is thus in the insurance providers' & their employees (e.g. networked allopaths) best interest".

Less-then-optimal health results in more medical expenses, which the insurance has to pay for.

Your argument doesn't add up.

Healthy population = less claims for insurance companies = more money for insurance companies.

Anything less then a healthy population, equals more claims which means less money for insurance companies.