NPR's All Things Considered ran an excellent story today called "The Telltale Wombs of Lewiston, Maine," about the extraordinarily high rate of hysterectomies performed on the women in that town. (If the trend continued, 70% of Lewiston women would have their uterus removed.) But more than that, the piece offers insight into how doctors often make decisions about medical care not only based on science and evidence, but also on the quirks of local medical culture, how many other doctors there are in town, and, of course, money. Reporter Alix Spiegal notes:
Talking to doctors about money is difficult. It's uncomfortable both for patients and for doctors to think that this most important and intimate service could be contaminated. But the truth is the decisions made by your physician when you enter his office are profoundly influenced by the way that doctors get paid in this country. "That's just common sense. That's human nature," says Smith of the Maine Medical Association. "The payment system is an important influence."
Most of the doctors in this country are not on a salary but are paid basically like pieceworkers in a clothing factory. This is called "fee for service," and the way it affects doctor behavior is clear. "If you pay people more, the more things they do, they're going to do more things," says Smith.
The U.S. health care payment system rewards doctors for taking action and doing procedures. This reality is so powerful that it hasn't just changed the individual behavior of doctors. Keller says that the specialties themselves have changed, bending like flowers to the sun, moving toward the source of heat.
This program aired on October 8, 2009. The audio for this program is not available.