JK Anand's commentary is spot on and makes the case for health care reforms that have long been been avoided. Paternalism, the selfish greed of many medical practitioners, the profit-seeking interests of the pharmaceutical and medical device industry, and the compliant expedience of politicians explain why these reforms have not been adopted.
Paternalism--"the doctor knows best"--is always a moral hazard for physicians and is a clear and present danger for patients in every encounter with a physician.
Payment of fees for service invites fraud and abuse. How could it be otherwise in a system that operates largely on the ill-founded assumption that physicians are committed to their patient's best interests, including the patient's and society's ability to pay?
So-called "quality" is an ill-defined and elusive concept in the practice of medicine, as the BMJ editor recently editorialized when pointing out the unrelieved uncertainty of medicine (1).
And, yes, paying doctors on a fee-for-service basis to report harmful side-effects of the medicines they prescribe would leverage the perverse incentives of the fee-for service system to produce a tad more of enlightened practice of medicine.
1. Godlee, F. Unrelieved uncertainty. BMJ 2017;358:j4347.
Competing interests: No competing interests