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Comment by nradov | Hacker News Reader

There are problems with the fee-for-service financial model but this isn't one of them. The doctor will be paid the same for the office visit regardless of whether they prescribe or not. The money for any antibiotic goes to the pharmacy, pharmacy benefit manager, and pharmaceutical company.

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You're neglecting customer loyalty, and patient throughput. A doctor who (correctly) says "there's nothing I can do for you; ger some rest and you'll get better" will be seen as "uncaring" and patients will de-register from their practice. They'll also have to spend time arguing / "educating" obstreperous patients, and earn less. A doctor who writes a (perhaps unwarranted) prescription finishes the visit faster, and gets better patient reviews.

I'm not making this up. A medical provider up-thread made this point.

That's a separate issue unrelated to the fee-for-service financial model. The same issue would still exist under any model where patients can pick their providers, including capitated VBC.

Makes me wonder why there is such a death grip on the fee for service model?

Fee-or-service is the simplest and lowest risk model for providers. Anyone can submit a claim using a standard EDI transaction or paper form. Capitated models only work for larger health systems that can deliver most common services under one roof, and that have the necessary IT and actuarial competence to price risk for a patient population accurately. There is an emerging set of technical standards which can make this a bit easier.

https://www.hl7.org/about/davinci/

Yes, ignorant clients 'beg' the magic bullet.

Practices are usually very granular and are tracked in detail, so increments for this/that abound. I suspect they would gather this low hanging fruit.

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