We need to get the incentives right

“Like their counterparts throughout the country, most of Brown’s newest medical school graduates are not interested in primary care.” So read the article in the Providence Journal this morning.

The article went on to say that of the 86 fourth year medical students, only four were choosing family medicine and nine pediatrics.  “What it really boils down to is procedure-intensive medicine. That’s what pays the high salaries,” said Dr. Philip A. Grupposo, associate dean of medical education.

The World Health Organization ranks the United States first in the world in costs, but only 37th in performance (2000 rankings). We are 29th in the world in infant mortality, 41st in the world in life expectancy.

“Saving our economy is inextricably tied to strengthening the health of our nation,” said Jeffrey Levi, Ph.D., Executive Director of Trust for America’s Health. “This investment … could make a major difference in improving the health of Americans and preventing disease, which is one of the most effective and overlooked ways to reduce the healthcare costs that are currently overwhelming our health system, businesses, and American families.”

Our hospitals loose money when people don’t schedule costly procedures. Our municipal water supply systems loose money when people conserve water. We don’t raise as much in gasoline taxes when we don’t drive and our states loose money when people stop gambling. Wall Street’s top brass receive huge bonuses for losing billions of dollars.

Our small sector of community benefit organizations deal with the aftermath of this inverted system. As we are learning, it is simply not sustainable. Nor good for our personal or societal health.

It’s time to rethink the way we spend money. We have to shift the incentives, so that prevention and wellness pay, not the opposite.