Skip to main content

False Incentives

  • 90 Accesses

Abstract

No two countries are alike when it comes to organizing and delivering healthcare for their people. When the Prussian government sent Rudolf Virchow to Upper Silesia in 1848 to investigate the epidemic of typhus there, he identified hunger, poverty, and poor hygiene as the main causes. Virchow saw the state and the church as responsible. And his prescription? Not medicine, but political and social reforms: “Medicine is a social science, and politics is nothing more than medicine on a large scale”. So, Virchow became politically active in the Reichstag, the German parliament, and a constant proverbial thorn in the German chancellor Bismarck’s side culminating in the infamous Sausage Duel over a debate on the funding for the navy. Bismarck challenged Virchow the next day to a duel, but as the one challenged Virchow was allowed to choose the weapons, and he chose two seemingly alike sausages, one filled with trichinae (a worm which causes a deadly zoonotic disease) and the other a normal sausage. Virchow then asked Bismarck to choose his weapon and eat it, and then he will do the same. Bismarck’s representatives refused, and thus no duel was fought. In December 1884, Otto von Bismarck introduced the first large-scale compulsory insurance to establish universal healthcare. However, Bismarck’s original intentions were not genuinely social. His health insurance was a reluctant reaction to upheavals among the working class in the wake of the Industrial Revolution, and a way to secure a political advantage against the Socialist Workers Party. Thus, health = politics, and, notwithstanding the desire and goal to help a patient, an important and legitimate incentive for healthcare providers and organizations is money and profit provided the patient comes first. So, it is worth looking at the political and financial incentives in different healthcare systems.

This is a preview of subscription content, access via your institution.

Buying options

eBook
USD   19.99
Price excludes VAT (USA)
  • ISBN: 978-3-030-95293-8
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Hardcover Book
USD   29.99
Price excludes VAT (USA)
Fig. 6.1
Fig. 6.2
Fig. 6.3
Fig. 6.4
Fig. 6.5

Notes

  1. 1.

    Baasch A. (2019) Rudolf Virchow: politics as medicine on a grand scale. Stories of Democracy; https://www.demokratiegeschichten.de/rudolf-virchow-politik-als-medizin-im-grossen/

  2. 2.

    Healthwatch (2021) Twin crisis of access and affordability calls for a radical rethink of NHS dentistry, https://www.healthwatch.co.uk/news/2021-05-24/twin-crisis-access-and-affordability-calls-radical-rethink-nhs-dentistry

  3. 3.

    Schneider EC et al., Mirror, Mirror 2021—Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries, Commonwealth Fund, https://doi.org/10.26099/01DV-H208

  4. 4.

    Health Care Data: Expenditure (2020) Verband der Ersatzkassen; https://www.vdek.com/presse/daten/d_versorgung_leistungsausgaben.html

  5. 5.

    Jahns T. Turnover of a dental practice, https://www.praxisgruendungen.de/umsatz-einer-zahnarztpraxis/

  6. 6.

    Zieglmeier M (2020) The concealed reason. Deutsche Apotheker Zeitung 25:42, https://www.deutsche-apotheker-zeitung.de/daz-az/2020/daz-25-2020/der-verschwiegene-grund

  7. 7.

    Aachener Zeitung (2010) Fraud: University hospital now has 60,000 euros in play money, https://www.aachener-zeitung.de/nrw-region/betrug-uniklinikum-hat-jetzt-60000-euro-spielgeld_aid-27210397

  8. 8.

    Fuchs F (2010) Dangerous germ in the hospital. Süddeutsche Zeitung, https://www.sueddeutsche.de/muenchen/patienten-mit-erreger-infiziert-gefaehrlicher-keim-im-klinikum-1.149298

  9. 9.

    Deutsche Krankenhaus-Gesellschaft (2019) Bestandsaufnahme zur Krankenhausplanung und Investitionsfinanzierung in den Bundesländern, https://www.dkgev.de/fileadmin/default/Mediapool/3_Service/3.4._Publikationen/2019_DKG_Bestandsaufnahme_KH-Planung_Investitionsfinanzierung.pdf

  10. 10.

    Thöns M (2018) Patient ohne Verfügung - Das Geschäft mit dem Lebensende, Piper, 336pp; https://www.piper.de/buecher/patient-ohne-verfuegung-isbn-978-3-492-31219-6

  11. 11.

    DIGAB (2017) Outpatient intensive care after tracheostomy. Deutsche Medizinische Wochenschrift 142:909–911, https://doi.org/10.1055/s-0043-109101

  12. 12.

    Spierling J (2019) Coding guidelines for critical care contexts. Medtronic, https://medinfoweb.de/data/CMM_Multicontents/files/PM/20190731_medtronic_kodierhilfe_intensivmedizin.pdf

  13. 13.

    Damuth E et al. (2015) Long-term survival of critically ill patients treated with prolonged mechanical ventilation. A systematic review and meta-analysis. Lancet Respiratory Medicine 3:544–553, https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(15)00150-2/fulltext

  14. 14.

    Langer S et al. (2013) Dealing with living wills: Problems caused by blanket formulations. Dtsch Arztebl 110:A-2186/B-1924/C-1870, https://www.aerzteblatt.de/archiv/149204/Umgang-mit-Patientenverfuegungen-Probleme-durch-pauschale-Formulierungen

  15. 15.

    German Society for Orthopaedics and Trauma Surgery (2015) Fallpauschalen liefern falsche Anreize, https://dgou.de/presse/pressemitteilungen/detailansicht-pressemitteilungen/artikel/dkou-2015-fallpauschalen-liefern-falsche-anreize/; Deutsche Krankenhaus-Gesellschaft (2019) Bestandsaufnahme zur Krankenhausplanung und Investitionsfinanzierung in den Bundesländern, https://www.dkgev.de/fileadmin/default/Mediapool/3_Service/3.4._Publikationen/2019_DKG_Bestandsaufnahme_KH-Planung_Investitionsfinanzierung.pdf; Habit S (2013) Falsche Anreize, überflüssige Operationen. OVB Online, https://www.ovb-online.de/weltspiegel/wirtschaft/falsche-anreize-ueberfluessige-operationen-2992387.html; Editorial (2012) Techniker Krankenkasse criticizes superfluous back surgeries. Dtsch Arztebl, https://www.aerzteblatt.de/nachrichten/49679/Techniker-Krankenkasse-kritisiert-ueberfluessige-Ruecken-OPs

  16. 16.

    Beard DJ et al. (2018) Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet 391:329–338, https://doi.org/10.1016/S0140-6736(17)32457-1

  17. 17.

    https://www.bloomberg.com/view/articles/2017-01-17/the-myth-of-the-medical-bankruptcy

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Schmidt, H.H.H.W. (2022). False Incentives. In: The end of medicine as we know it - and why your health has a future. Springer, Cham. https://doi.org/10.1007/978-3-030-95293-8_6

Download citation