Healthcare is a uniquely fraught enterprise that deals with uncertainty, vulnerability, tragedy, hope, and trust. But he never claimed to be as smart as the guys who ran Lehman Brothers.įor the hundredth time in a seemingly infinite series, the world is learning two key lessons: you don't get something for nothing, and appealing to baser instincts will improve neither humans nor their achievements. IKEA CEO Anders Dahlvig refuses to take his company public precisely to avoid the tyranny of get-rich-quickism that makes a virtue of impatience and myopia and rewards Ponzi schemes over substance. You get what you pay for, and the denizens of Wall Street decided to pay for scams so absurd that they make the Nigerian please-be-my-agent-for-millions howler look like Protestant-ethic capitalism at its sober best.
#Pecunia vincit omnia how to#
They sure knew how to tally up the performance points. Ask not for what the bell tolls - it tolls for fee.īut what if we're just learning, and eventually get it right, particularly if we learn from our masters in the private sector? You're doubtless as inspired as I am by the corporate CEOs with incomes almost entirely driven by the value of their (occasionally back-dated) stock options and the quarterly earnings statements. So it's hardly any wonder that British GPs are walking away with the dough. All nuance and complexity are obliterated by the basic algebra of the payout.
Moreover, the game will inevitably lack sophistication, because to dole out the rewards, the goals must be clear and simple the results easily measurable and immediate and the reach modest (no one will play if it's too hard to win). Set up the game and people will learn the rules and play accordingly. Adopt its assumptions and fund or pay accordingly and you will indeed turn civilized people into econocentric shadows of their selves.
So let's tell them what to accomplish, ring the economic bell and watch the Pavlovian throng stampede to improvement via the cash-stuffed trough.ĭishearteningly, P4P writ large becomes a self-fulfilling prophesy.
Managers and practitioners are hardened cynics for whom pecunia vincit omnia - cash conquers all. It is a profoundly pessimistic concept of what makes people tick in health care: we can't rely on organizational culture, professionalism, devotion to public service, or commitment to excellence to get the desired results, so let's just concede that it's all about the money. On examination, the very essence of P4P is troubling. But the number of complaints per practice - one reasonable measure of satisfaction - varies considerably. The average GP practice scores 95% of the bonus-triggering points available and virtually all get 90% or more.
In the UK, the vaunted GP bonus schemes - which can add tens of thousands of pounds to physician incomes - have turned into base pay. The Hay Group believes that even 5% to 10% of income at risk is insufficient to produce a significant effect, let alone the 1% to 2% typically on the table in such arrangements. Renowned British health economist Alan Maynard found lots to be cautious about in his review of experiences to date. Well, yes, if you overlook the P4P track record.
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