Encouraging physicians to strictly limit the budgets of each patient's care will surely drive down costs and may even conspire to encourage physicians to improve patient preventative care. But there is always the fear that patients will be denied necessary as well as unnecessary tests and procedures, and physicians may shy away from suggesting expensive but potentially life-saving treatments.
This new system essentially splits the interests of physicians and patients: the less care physicians give, the more physicians are paid. Furthermore, there is a strong disincentive to treat potentially uncooperative or risky patients. Patients who have mental health issues or who have chronic conditions that are unpredictable and difficult to treat, such as the obese and diabetics, may fall under such categories. However, these patients are often the individuals most in need of intensive, hands-on care and a close relationship with their physicians.
Impact on practitioners
Practitioners will be frustrated by the new system because accountants and actuaries will be attempting to dictate patient care, rather than the physician's own medical judgment. Every patient is an individual, and every condition is individualistic...
Under Prometheus, physicians lack the discretion to create a treatment plan that will be effective -- instead, they must focus on making plans cost-effective.
The one positive benefit for physicians is that they may have an 'excuse' when patients demand treatments that are blatantly contraindicated or useless -- such as a mother who demands an antibiotic for her child with a cold, or someone who has an anxiety disorder and demands a cardiovascular stress test for his or her pounding heart. Explaining that the treatment guidelines do not financially cover such a procedure could be used as a defense by the practitioner
At present, healthcare in America exists in a state of extreme imbalance -- individuals with comprehensive insurance have little incentive to limit their consumption of care. In contrast, individuals without insurance, or with very bare-bones levels of insurance, struggle to pay for any type of care at all. The proposed 'Prometheus' plan would limit some of the excesses of so-called Cadillac plans, but may end up simply harming more individuals than helping others. It would limit the care dispensed to some, but would do little to increase the incentives to expand care to others.
