Not all conditions are the same, and not all manifestations of the same condition are the same. You used the example of pneumonia. Not all Pneumonia cases are not treated the same. Pneumonia isn't even a disease. It's a symptom of what is usually (in humans) a bacterial infection in the lungs. There are many different types of bacteria that can cause pneumonia. It can also be viral or fungal.

In all cases of disease, treatment protocols are going to be subject to variance. There are variants in bacteria strains and susceptibility. There are variants in the ability of the patient to fight off and handle the disease with and without treatment.

A 80 yr old woman who just had heart surgery and developed a bacterial pneumonia caused by a Klebsiella bacteria picked up in the hospital is not going to be treated the same as a robust 12 yr old boy with walking pneumonia. The old woman is going to require intensive care, fluids, different antibiotics (probably stronger injectible antibiotics). The boy will probably be told to rest, drink lots of fluids, and will sent home with azithromycin (which is relatively cheap).

It is unfair to the doctors or the patients to charge those two clients the same. If you charge based on solving a difficult pneumonia, you're over charging the boy's parents. If you charge based on the boy's pneumonia, you're going to put the doctor out of business while treating the old woman.

The only way to make the system balanced is to make a system that has defined costs for multiple manifestations of every disease. Do we need to go into how ridiculous that would be?

And, while I can't speak for human hospitals, I know in veterinary hospitals we DO charge in the manner you speak...to an extent. Regularlly performed procedures will have various levels. There's a Level 1 dental (Basic cleaning), Level 2 dental (which might include a particularly difficult cleaning, or maybe an extraction), Level 3 dental (multiple extractions), etc...etc... But we just can't do that for "Pneumonia". Because every animal is going to be treated just a little differently, which incurs different costs FOR THE HOSPITAL.

In the end, one must run these places like a business because you can't treat anyone without money to run your practice!! Unless the government/insurance/other entitiy is going to swoop in and pay things for the doctor, of course...

I don't mean to say that your idea would never work our couldn't be implemented. I think for a lot of day-to-day things, it's feasible to charge based on condition. But I think it's impractical do to do for everything. Medicine is just too complex for that.

On another note, I think it's outright wrong to base payment purely on solving the problem (i.e. curing a disease). First of all, there are tons of diseases (most cancers come to mind) that can never be truly cured. Or at least it's impossible to detect whether they're 100% cured (ex. a 99.9% reduction in cancer cells still leaves at least a million cancer cells which can grow again...) Secondly, there are so many factors that go into the success of a treatment protocol. Many of those factors are entirely out of the doctor's control (environmental factors and patient variability factors, for the most part). And, in the end, we just don't have solutions to every disease. For some diseases, we don't even have good ways to handle the symptoms.

I'd say there's no quicker way to make doctors give unnecessary tests and treatments than tell them that if they don't succeed, they don't get paid!!

Also, how do you propose that this would work for cases that end up being referred on to specialists? If I walk in to my primary care doctor with a dermal lesion, he'll do the best he can, but he might end up referring me on the the dermatologist who is better able to diagnose the problem. Should he be refused payment for his time and advice? Or do you want to create a situation where doctors are refusing to pass on cases they shouldn't be handling because otherwise they won't make any money? My brother has been through doctor after doctor after specialist after specialist trying to figure out his neurological problem. I don't think any of them don't deserve to be paid because they can't figure it out. He has a complicated problem that doesn't fit the pattern for anything in particular! It's not his doctor's fault that it's not easy.


I'm not saying you necessarily intended all these nuances and that's fair enough. I'm just responding to only what you said. My point is just that it's not that simple and I expect would create more problems than just charging based on an itemized fee schedule. Honestly, as a patient, I'd rather see the itemized fee schedule!! It's easier to see if/how I'm being overcharged.

I dunno. I mean, I may be totally off base. This is just how I see it, but I'm not exactly involved with human medical billing. I just know how I've been charged, how billing ends up working for veterinary medicine and how we charge and the economic situation we have in running a practice. I can't imagine it's too different, except for the presence of insurance altering the game. And we're talking about if that wasn't there, aren't we?