[Skip to Navigation]
June 2014

The Argument Against Reimbursing Physicians for Value

Author Affiliations
  • 1Pulmonary and Critical Care Medicine, Christus St Vincent Regional Medical Center, Santa Fe, New Mexico
JAMA Intern Med. 2014;174(6):845-846. doi:10.1001/jamainternmed.2014.1063

Since the time of Hippocrates, it has been assumed that a physician’s first obligation is to provide the best possible care to individual patients, without distortion by competing societal interests.1 This once near-sacrosanct principle is being tested by the high costs of the health care in the United States, which increasingly threaten the economy. Because physicians control much of the delivery of health care, they have a natural role in helping to control health care costs. But historically, our society has been uneasy about assigning this role to physicians. When people are sick and helpless, do they really want their physicians to be influenced by costs, or do they need to believe that their physicians want only to serve them according to their medical needs?

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    I agree with the author's main points, but.....
    David L. Keller, MD | none
    The decision \"to provide less or cheaper care\" will not \"end up being based on the belief system (or susceptibility to financial incentives) of individual physicians\" for the increasing percentage of employed physicians. Providing less or cheaper care will be mandated by management executives, driven a powerful double incentive: spending less contributes dollars directly to the bottom line, and the cost savings result in additional \"value\" bonuses from Medicare and insurers. Those dual incentives will certainly be passed through to physicians, and are the reason that physician compensation based on \"salary, without bonuses or withholds\" will not be implemented by most organizations which employ physicians. My second observation is that one cited study reported that \"in many geographic areas, higher spending is associated with worse health outcomes\", but another study reported \"that lower spending at the patient or hospital level is associated with poorer outcomes for patients\". The association between higher spending and worse health is counter-intuitive, while the association between lower healthcare spending and worse patient outcomes comports with a belief in modern medicine. How can these opposite outcomes associated with healthcare spending be reconciled?