Money-Driven Medicine, Again

One of the tenets of the “consumer-directed” health care movement is that consumers need more “skin in the game” of health care–the bigger share of care they pay for, the more they’ll economize (perhaps by avoiding genetic predispositions to illness?). But I don’t think this is the kind of skin they had in mind (from Natasha Singer’s article “As Doctors Cater to Looks, Skin Patients Wait“):

[D]ermatologists nationwide are increasingly hiring nurse practitioners and physicians’ assistants, called physician extenders, who primarily see medical patients, according to a study published earlier this year. . . “What are the physician extenders doing? Medical dermatology,” Dr. Allan C. Halpern, chief of dermatology at Memorial Sloan-Kettering Cancer Center in Manhattan, said in a melanoma lecture at a dermatology conference this year. “What are the dermatologists doing? Cosmetic dermatology.”

According to a presentation for doctors from Allergan, the makers of Botox, a medical dermatology practice might have a net income of $387,198 annually, but a dermatologist who decreased focus on skin diseases while adding cosmetic medical procedures to a practice could net $695,850 annually. The same material advises doctors to “identify and segment high priority customers.”


Meanwhile, here’s one more triumph for those crusading to keep “big government” out of health care:

Months after routine hip replacements, patients who had expected to live without pain were in agony. . . [A doctor] found he had implanted the same metal hip socket in each patient. Several needed surgery again — a replacement for their replacement. The doctor first told the device’s manufacturer . . . last year about his concerns but nothing happened. . . .

Last week, Zimmer announced it was suspending sales of the device, known as the Durom cup, until it trained doctors how best to implant it. The company said a “low” percentage of the 13,000 patients who got the socket would need replacements, but some doctors fear the number could reach into the hundreds.

If those patients lived in other countries where artificial joints were tracked by national databases — including Australia, Britain, Norway and Sweden — many might have been spared that risk. And Zimmer might have suspended sales of the cup months ago.

But the United States lacks such a national database, called a joint registry, that tracks how patients with artificial hips and knees fare. The risk in the United States that a patient will need a replacement procedure because of a flawed product or technique can be double the risk of countries with databases, according to Dr. Henrik Malchau of Massachusetts General Hospital.

But of course, the US has nothing to learn from those unfortunates stuck with “socialized medicine.” Imagine all the paperwork such a registry would saddle poor device manufacturers with.

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