This is on the money, it’s all about incentives. In Australia there is a public and a private health system. In public, the surgeons are paid a salary which is the same whether they do 1000 or zero operations. In private they are paid per procedure, with zero salary. The probability of getting an operation is very different for the same condition in public and private.
Except they aren't necessarily paid more for surgery. That is a common misconception. Surgeries take time. Not just for the surgery, but the prep time before and then the aftermath.
-For example, a bit of searching shows an appendectomy takes about an hour. Lets add 1/2 hour onto that for prep & cleanup.
-Searching indicated about $900 to $1200 is the typical insurance payment to the surgeon. That's $600 to $800 an hour.
-Based on my own insurance claims, specialist visits are reimbursed from $200-$300. Average 10 minutes per visit and that works out to $1200 to $1800 and hour. (Non specialist annual "wellness" checkup/physical was reimbursed around $180 for $1080 an hour)
Certainly not all surgeries are necessarily the same, so rates may vary and there could be more or less $/hour, although the same goes for office visits. As such, doctors already are paid roughly similar, or close enough that concerns of pushing surgeries for the $$$ probably don't need to be a huge worry.
No. Doctors are not bureaucrats. They have a 1 on 1 relationship with a patient and they do want to help them (this fact seems lost on many people). You don’t need to incentivize them to do the right thing, it is more that perverse incentives interfere with how things should be, for example performing pointless revascularizations.
