Incentives to Avoid Misdiagnosis Lacking

David Lowe

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If we are to improve upon the alarming rate of physician misdiagnosis of illness, pay-for- performance is the way to go. But political will is going to be required to make this structural change in the health care system.

A New York Times Story asks why doctors so often get it wrong in diagnosing illness. It appears that the answer lies in a failure of the health care system to reward success in diagnosis and to discourage misdiagnosis.

According to the story:

Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease. As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930's. "No improvement!" was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation.

The article comments that the system does not provide incentives to get the diagnosis right; just to order tests, do surgery and dispense medicine.

According to Dr. Mark B. McClellan, administrator of Medicaid and Medicare, and former commissioner of the U.S. Food and Drug Administration, "We just are not using the power of incentives to save lives." The article describes the beginnings of efforts in the federal programs and some in the insurance industry to introduce "pay for performance" programs, but observes that the push is insufficient.

If we are to improve upon the alarming rate of physician misdiagnosis of illness, pay-for-performance is the way to go. But political will is going to be required to make this structural change on the health care system.