1: "Hi, everybody!" -- Dr. Nick Riviera as the Model Consumerist-driven Physician2: 7 Famous Medical TV Shows
3: Healthcare Concept Map
4: 13 Somewhat-forgotten Medical TV Shows
5: Adverse Selection in Health Insurance
Wednesday, December 31, 2008
Top 5 Blog Posts of 2008
The following are the most popular Medical Pastiche posts from 2008:
1: "Hi, everybody!" -- Dr. Nick Riviera as the Model Consumerist-driven Physician
2: 7 Famous Medical TV Shows
3: Healthcare Concept Map
4: 13 Somewhat-forgotten Medical TV Shows
5: Adverse Selection in Health Insurance
1: "Hi, everybody!" -- Dr. Nick Riviera as the Model Consumerist-driven Physician2: 7 Famous Medical TV Shows
3: Healthcare Concept Map
4: 13 Somewhat-forgotten Medical TV Shows
5: Adverse Selection in Health Insurance
Tuesday, December 23, 2008
Tuesday, December 16, 2008
The Prisoner's Dilemma: Medical Game Theory
In light of a recent opinion piece, commented on by others, it deserves to be shown, through game theory, how two groups of physicians (specialists and generalists) are being pitted against each other by a third party, namely the federal government through CMS through the RVS Update Committee (RUC).
Game theory helps to predict and explain interactions in social decision-making. The classical problem is the "Prisoner's Dilemma" wherein two prisoners are pitted against each other by a third party seeking to expose the crimes of the imprisoned through betrayal of each other.
The incentive for prisoner A to betray prisoner B is the possibility that if the betrayer (prisoner A) is alone in betraying the other, prisoner A will go scot-free while the other prisoner receives the full prison term. If both prisoners betray each other, they both go to prison, but both receive a shorter prison term.
Do physicians cooperate or do they betray each other?
Rather than cooperating with each other to get rid of a corrupt payment system which favors certain groups of physicians versus others in a budget-neutral fashion, these groups of physicians fight each other to get a larger piece of an increasingly smaller pie.
The only real winner is the government at the expense of all physicians.
Unlike the original prisoner's dilemma, the medical game is not over yet. Physicians still have time to set aside past wrangling over the payment system and to fight the RUC.
Game theory helps to predict and explain interactions in social decision-making. The classical problem is the "Prisoner's Dilemma" wherein two prisoners are pitted against each other by a third party seeking to expose the crimes of the imprisoned through betrayal of each other.
The incentive for prisoner A to betray prisoner B is the possibility that if the betrayer (prisoner A) is alone in betraying the other, prisoner A will go scot-free while the other prisoner receives the full prison term. If both prisoners betray each other, they both go to prison, but both receive a shorter prison term.
Do physicians cooperate or do they betray each other?
| Generalists fight RUC | Generalists betray | |
| Specialists fight RUC | The broken system is removed | Generalists' pay increased Specialists suffer |
| Specialists betray | Generalists suffer Specialists' pay increased | RUC is maintained All physicians suffer |
Rather than cooperating with each other to get rid of a corrupt payment system which favors certain groups of physicians versus others in a budget-neutral fashion, these groups of physicians fight each other to get a larger piece of an increasingly smaller pie.
The only real winner is the government at the expense of all physicians.
Unlike the original prisoner's dilemma, the medical game is not over yet. Physicians still have time to set aside past wrangling over the payment system and to fight the RUC.
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