Excessive costs in health care are driven by multiple incentives. They may not be additive.

Firstly, patients will always want more care believing that they have obtained better care in so doing. Patients are known to change doctors if they feel that not enough tests or procedures have been ordered. This is observed numerous times by physicians frequently to their chagrin.

Secondly, hospitals have been known to treat physicians and surgeons with greater regard who ordered more tests and obtained more inpatient procedures, all of which improve their bottom financial line. Although quality of care (QOC) is mentioned, it is not the guiding principle.

Thirdly, hospital administrative committees have sent letters of Peer Review if they feel not enough tests and/or procedures have been ordered or for minor variations in patient evaluations. This frequently is not quality driven. On increasing occasions this is directed to physicians as the initial administrative action to eventual termination of privileges of physicians and surgeons for various economic or political reasons. This has been termed “Sham Peer Review” which has little to do with quality of care, the initial impetus to implement the entire Peer Review program.

Finally, this has led to the “Physician Data Bank” where Peer Reviewed physicians, who do not survive after limited legal actions were unsuccessful, are sent termination letters eliminating their medical privileges and consequently their medical practice. The legal challenges are severely limited. Frequently no attorneys are allowed; cross examination is very limited; hearsay is frequently accepted as fact; conflict of interest is disregarded inasmuch as the prosecuting physicians are frequently in competition with the doctor being Peer Reviewed.

Hence, the “Physician Data Bank” functions primarily as the “Permanent Tomb” for the physician and surgeon who are in disfavor by a competing medical group or the hospital,  The half million invested in their education is buried with the physician, Frequently, his wife and children leave him because of this extreme humiliation. With no income, these physicians have a high incidence of severe depression and suicide.

What an ignoble end to a noble professional career.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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