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Problems With Incentives

James S. Todd, MD
JAMA. 1990;264(10):1294-1295. doi:10.1001/jama.1990.03450100084032.
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Few would argue that our current methods of financing and delivering health care are without severe problems and inadequacies. So much so that many (more out of despair than conviction) would scrap the whole model for the unknown consequences of what is perceived to be a more equitable and perhaps less expensive system.

Most of those who espouse this concept argue that the only way to gain control of rising expenditures and the uninsured population is by converting to a single-source funding mechanism. This, they believe, will restore equity, equalize incentives, and guarantee health care to all without the interposition of personal financial considerations.

Throughout much of these discussions, the issue of incentives and how to manipulate them assumes increasing importance. Some argue that the provision of adequate payment under any system will assure that care, sometimes of marginal value, will be given, but that at least the financial barrier


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