The story was that soon after Fred arrived, he was assigned to get on top of malpractice claims, and he sat down with six months’ worth of files. All of them, he discovered, began with a collection action for non-payment of a bill.
The rest of this story is no news to me (every 5-10 years some new piece comes out showing that apologies work, that many patients file suit simply so that they can find out what happened in the face of hospital/physician stonewalling blah blah blah) but this part was a little different, and I wonder if it still applies. 25 years ago, health care was still about fee for service, so it made sense not to pay the bills of doctors you believed had done a lousy job. Now you pay your copays up front and get your bill for a particular stint in the hospital filtered through your insurance company, with supplementary bills for uncovered amounts from randomly-named medical corporations, and you’re lucky if you can even figure out which bill (or part of a bill) goes with which doctor’s treatment.
This 25-year-old anecdote may be one of the very few cases where market signals (people refusing to pay for what they considered lousy treatment) actually had some relevance in health care. And now those particular signals have been mostly erased.
(And although hospitals and physicians continue to get their acts together, there are still glitches — the first piece of postmortem mail we got from the hospital where my mother died was a questionnaire about whether she had been satisfied with her care during her recent stay. Perhaps the database logic needed just a little extra branch point.)