When I was young, I would go to Florida to visit my grandparents. In their garage, they have an old white Toyota Corolla. Despite the age of the vehicle, it is still intact. After all, it is only 300 miles. Not 300,000 miles—no comma needed—just equivalent to the full trip from Jacksonville to Miami on the odometer. My grandparents reserved this car specially for “driving” to visit relatives. These quotations are very important.
When I reached the age to drive, my grandmother-now in her 80s, detained in the back with several cataracts worthy of praise-provided generous opinions and colorful comments on my driving. She specifically pointed out that I should not be too close to the car in front of me. But I can’t let the car behind follow too close. Someone told me clearly that I must accelerate and decelerate at the same time, and always do so.
This problem reappeared in a particularly memorable trip on I-95. I was stuck between slowing down to keep more distance from the car in front and accelerating to lengthen the distance to the car behind me. What if I choose to do neither, or just choose one of the above? I will choose my grandmother’s anger more accurately. If you know her, you will know that I don’t want to irritate her. Neither will you.
Therefore, although I may have been driving, I really don’t like it. This colorful anecdote has important similarities to how we experience, provide, and participate in the healthcare system. For many patients driving their own health journeys, the lack of control and confusing advice must feel very similar to the nervous driving of crazy passengers giving orders.
Who promotes healthcare?
Pushing change in the health sector is challenging because no one seems to be able to agree on who is pushing whom, when or where. In theory, the establishment of an ecosystem must first benefit patients. When we think of patient-centered care, we like to imagine that they are in a dominant position in their own health.
However, our current care delivery model is more like a bus. Everyone is instructing patients how to drive, where to park or get off, and there are usually conflicting inputs. Some people ask for the fastest route, some avoid (or encourage) tolls, and some tell patients to only take the road they are familiar with…accelerate, decelerate, turn, go straight, lean on the shoulder and avoid all this traffic.
The question of who promotes healthcare is not easy to answer, and it is not always answered in the way that best serves the driver. The rear-seat drivers cannot agree, turning and indicating directions in turn (to a large extent to satisfy their own interests), which ultimately prevents the patient from driving with sufficient confidence or expertise. This is a textbook explanation of the principal-agent problem. Although it does not originate from medical care, nor is it exclusive to medical care, the problem is particularly prominent.
Examples of principal-agent problems
Moral hazard arises when the priorities of individuals or entities (“agents”) that can represent (or influence) another (“principal”) make decisions or take actions (“agents”) are different. When providing nursing services, since the patient is clearly the client, this may also cause potential health hazards. The scope of principal-agent problems is as extensive and serious as the scale of the system and the types of agents.
Various people and entities subject to different interests, incentives and obligations usually make decisions on behalf of the patient. These agents are mainly divided into three categories: Payer, provider and caregiver.
Payer Pay for patient care, but every dollar allocated means less money for shareholders. Within the scope they deem appropriate and within the scope permitted by law and compliance, the payer can maximize profits by refusing to pay the patient for care.
supplier Efforts to make patients healthier, but must also comply with regulatory, legal and ethical requirements, and operate within budget and administrative constraints. They must also take action to ensure that they can continue to earn a living to support themselves, their families, and provide care infrastructure (ie staff, technology, permits, administrative expenses).
Caregiver To improve the health of patients, it is also necessary to make significant emotional investments in the patient’s journey. The desired outcome or the way the caregiver gets there may be very different from the outcome or the way the patient. For example, if antibiotics shorten the duration of a child’s ear infection by 24 hours, but increase the risk of diarrhea and other unpleasant side effects, then the choice of caregivers may vary depending on the severity of the infection, who must change diapers, Who wants to wake up at night with a crying child.
Solutions (and directions) for navigating the road ahead
A kind 2011 analysis Research on the prescription model of private providers in Vietnam suggests that having patients receive higher education may help alleviate the principal-agent problem in healthcare. The more patients understand their health and how healthcare works, the more confident they will be in advocating on their behalf, and the more likely they will be to weigh all treatment or prevention options appropriately, or to oppose redundant treatments.
The analysis also recommends improved regulatory oversight and public-private cooperation to better align the incentives of providers and payers with the interests of patients. Tennessee State University Published ten years ago.
Of course, the motivation is still the less invisible hand on the steering wheel. In order to further balance the input scale between patients and agents, Presentation in 2012 in The 4th International Science Conference A payment system is proposed to “maximize the motivation of doctors in order to maximize the utility of patients.”
This utility-based reward system essentially must encourage the best resource consumption. Optimal has found the best point between our current ruthless efficiency and the redundant and excessive double systemic ills. When the system readjusts its incentives (financial, regulatory, professional, emotional) to be more closely aligned with patient outcomes, care can focus more directly on the interests of patients.
Enable the patient to master the steering wheel
Promoting advancement in healthcare means helping patients as often and professionally as possible drive Instead of “driving.” This needs to be patient-centric and protect the sacred trust in the patient-provider relationship. The principal-agent problem, even if it is not directly caused by the supplier itself, will erode this trust. Payers, caregivers, providers, and the larger healthcare ecosystem all play a role in aligning with what is most beneficial to patients and valuing their trust first.
The easiest way for patients to master the steering wheel on their health journey is to remind them that they are drivers at every turn and equip them with education, confidence, transparency and support systems to keep their eyes on the road and they want The destination is within reach. The less driving in the back seat, the more likely the patient is to listen to important opinions or solve problems on their own.
Otherwise they will end up like me, with my grandmother sitting behind Corolla on I-95 in Florida. That day, wandering between acceleration and deceleration but wanted to do it at the same time, I thought I had found a very clever way: I pointed to the mirror and pointed out to her that the car behind us was not that close.
But my grandmother would not be so easily deceived, because the back view clearly shows that “the objects in the mirror are closer than they look.”
“Oh,” she said, “even worse It’s better than I thought. You better change lanes. “
of course.Now why not I Miss that? after all, I It’s the one who drove.
Photo: Phuket, Getty Images
