There is an interesting study in this week’s Annals of Internal Medicine which reports on the relationship between types of Medicare Advantage plans and their quality of care ratings. Over the past years since Medicare Advantage plans have been implemented, each plan has been given a score from 1 to 5 stars. This journal article looked to see if there were patterns across the galaxy of plans.
Their conclusions are as follows:
“In 2010, nonprofit [Medicare Advantage] contracts received significantly higher star ratings than for-profit contracts. When comparing health plans in the future, [Medicare] should give increasing attention to for-profit plans with lower quality ratings and consider developing programs to assist newer and smaller plans in improving their care for Medicare beneficiaries.”
To paraphrase, they found that nonprofit plans provided better quality care than for-profit plans. What this underscores is that incentives shape behavior, in both conscious and unconscious ways. A for-profit corporation is legally required to maximize profits for its shareholders, while a nonprofit can have its core mission be to better the health of its members.
Those missions trickle down to the care practitioners, and I had a stark reminder of that as a patient this past week. I had seen two different private dentists, and each said I needed a semi-major dental surgery. On the day of the operation, the periodontist sat me down, and said my case was borderline: surgery was a valid option, but so was doing nothing and monitoring the situation. We discussed the situation for 15 minutes, and I walked out of the office with the most painless type of surgery: none.
This periodontist left an impression on me. He told me verbatim, “My job is to do what is best for my patients not to maximize the billing sheets.” My walking out of his office was $2,000 out of his pocket. In a circumstance like mine, would there have been the same result if he had worked in a for-profit institution? In borderline cases like mine, financial incentives can influence healthcare decisions.
As medical students, we have one foot in each realm: not quite patients and not quite doctors. From my vantage point in each, the impact of profit motives in this industry, which is 17.2% of US GDP, is often subtle but omnipresent.