Money and the Changing Culture of Medicine  

Oleh:

Hartzband, Pamela ; Groopman, Jerome

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 360 no. 02 (Jan. 2009), page 101-103 .
Topik: behavioral economics and psychology

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2009.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Rapidly rising health care costs over recent decades have prompted the application of business practices to medicine, with the goals of improving efficiency, restraining expenses, and increasing quality. In the wake of the current economic crisis and the advent of a new presidential administration, even more attention will be focused on containing costs in the health care system. Price tags are being applied to every aspect of a doctor's day, creating an acute awareness of costs and reimbursement. Physicians are now routinely provided with profit-and-loss reports reflecting their activity, and metrics are calculated to measure the cost-effectiveness of their work. Many business managers believe that clinicians will change their behavior to meet the imperatives of increased efficiency, cost containment, and improved quality only by increasing their focus on the flow of money in their work environment. But are there unintended consequences of applying a business mindset to medicine? Results from studies in behavioral economics and psychology suggest that there may be. Assigning a monetary value to every aspect of a physician's time and effort may actually reduce productivity, impair the quality of performance, and thereby even increase costs. Not long ago, we overheard two colleagues talking in the hall. One physician asked the other for his thoughts on a complex case; despite a busy schedule, he did not hesitate to stop and engage in thoughtful discussion. Now, imagine that they had just left a departmental meeting where the divisional budget was reviewed and goals for individual relative value units (RVUs, the monetary metric of physicians' time and effort) were presented. Would their interaction be different? Studies have shown that even the suggestion of money promotes behavior marked by selfishness and lack of collegiality.1 In one experiment, a control group performed a series of tasks, such as unscrambling phrases, in a "neutral" environment, whereas another group was "primed" through the inclusion of the concept of money in the scrambled phrases and the placement of play money within their visual periphery during the exercise. After the assignment was completed, a researcher posing as a subject entered the room and said that she was confused about the instructions for a certain task. According to the study results, control subjects spent twice as much time helping this "confused" peer as did those who had been primed with money. "Apparently," the researchers concluded, "participants who were primed with money believed that [the researcher posing as subject] should figure out on her own how to perform the task, as a self-sufficient person would do." In a series of such experiments, money-primed subjects were consistently less willing to extend themselves to those in need of assistance. The authors concluded, "Relative to people not reminded of money, people reminded of money reliably performed independent but socially insensitive actions."

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