Patients pick good doctors not bureaucrats


The government wants surgeons to receive extra pay for good performance when operating on their patients. State of the art quality of care is internationally getting ever more important but nobody has yet come up seriously with the idea of incentivising surgeons for good performance - measured in patient survival. For this is a very tricky thing to measure. You need a whole new layer of bureaucracy.

But even worse are the unintended consequences: as one consultant, responsible for cancer care, has put it:

We have got to ensure we don't create a dangerous precedent, that the surgeons doing the big complex cases aren't discouraged from taking them on.

It is obvious that the incentives would prod surgeons to focus on the patients with acute diseases rather than chronic ones because this delivers better survival scores. However, it would be absolutely counterintuitive,  as the NHS always was and still is by default biased heavily against the chronically ill. The reason for this is political meddling which is driven by short-term thinking glued to election cycles.

Patient outcomes are important as a standard between competing health care providers. But this is all about information for patients as consumers who can then compare quality and make choices. At present the performance information on hospitals in the NHS is almost useless and does not enable patients to choose on the basis of quality. This is the challenge the government strives to circumvent by reducing it to a contest between surgeons. But that won’t do. Only comprehensive outcome data reporting of all providers can extend competition to the hospital as a whole and enable them to address the worst problems first. Moreover, in times of ever rising healthcare spending, the best doctors should not be rewarded with bonus pay, but with more patients flocking to them and thus increasing their reputation and pay.