As part of what I do to pay the bills - I recently attended a conference that was all about how healthcare is funded and looked at a variety of different funding mechanisms including pay for performance and other funding structures.
I was struck by a variety things:
a) How incredibly complex some of the funding mechanisms were.
b) The intense focus on procedures, hospitals and providers of care.
c) The complete lack of focus on patients and outcomes.
The conference left me feeling as though the health care system has truly lost its way and has been micro-managed into losing its true sense of purpose (to serve patients and improve the health status of the population) and into a state of perpetual crisis (Waitlists! Affordability! Overcrowded ERs! Care delayed and denied!).
I can't help but be reminded of a child of a domineering parent who is over-scheduled and berated by a constant stream of demands - all of which on there own seem reasonable but combine to form some untenable and unhealthy state of being that undermine the true goals of childhood (to grow to be a functioning, independent adult who is a meaningful contributor to society).
I am also reminded of a business that has completely lost touch with its customers, what they want and need and has completely focussed on producing as much product as cheaply as possible - regardless of the demand for that product.
It's time for a massive shift - we need to refocus on what really matters in health care (health outcomes - most of which are very dependent on what the patient does or does not do) and to get back in touch with the 'customers' of the health care system. We need to better understand what they want and need and we need to start involving them more in the decisions that are made.
Furthermore, I don't think such a shift would neccessarily result in more costs - as the Nuka model of care demonstrates...