Health (De)Capitation

Imagine that your doctor gets paid to not provide you with a recommended treatment, literally, that he or she makes money for not taking care of your health as would be objectively expected.

Don't imagine. If you live in Puerto Rico's so-called Health Reform--and what mirrors it in many parts of the U.S.--that is the reality: Doctors make money for not treating your health properly.


Of course, this aberration has a name: capitation. In essence, doctors get paid a stipend per patient, but if they recommend that the patient see a specialist or have a further examination their stipend is reduced to help pay for that additional service. So it quickly becomes apparent that it is in the doctor's best interest to deny a patient's best option for treatment because it "costs" the doctor much more than the patient.

Say it ain't so? Doesn't change the reality. Proponents of capitation say that the purpose of the system is to reduce unnecessary medical visits and tests. What they fail to see--or pretend to be blind to--is that the system places the doctor's interests ahead of the patient's. Expecting doctors to be filled with the milk of human kindness and generosity is one thing: asking them to live up to it in a daily grind is entirely another.

For one, doctors have expenses, some of which (malpractice insurance, for example) are going through the roof. Are there insurance companies out there paying out huge settlements without passing costs on to their customers? No. So don't expect doctors to eat added expenses without "passing the cost" to their customers, namely by not letting money in their hands go elsewhere.

Second, and reiterating the above, doctors are human and humans are possessive and self-interested. It makes no sense to try to pretend otherwise. The catch in the health system's blind use of capitation is that the neediest element is strictly beholden to the less needy. A sick patient needs help, but their need is in the hands of a person who can willfully, often negligently, deny their greater need for well-being in favor of a merely monetary whim.

Am I saying that doctors will endanger a patient's life for mere money? Yes I am. If you think money isn't the issue just make the rounds (pun intended) of several medical offices in any part of Puerto Rico. It won't take you long to see signs stating that "Cash Only" is acceptable. No checks. No ATM or credit cards. And certainly, no medical plans, though the doctor is almost certainly on one or more medical plan capitation systems.

Is this right? Depends on who you ask, a sick person or a doctor. A key point is that there are plenty more sick people than doctors...and that there is often a startling and depressing overlap of what sick can actually be.


The Jenius Has Spoken.