Surprise! Incentives matter, even to upper middle class professionals

The most basic and fundamental thing you need to know about eonomics is that incentives matter. This is all that is required to understand this little snippet of news:

British patients face the shortest GP appointments and are least likely to see a doctor in person, an international study has found.

In most parts of the world doctors are paid when they see a patient. This may or may not mean that they then do something to solve said patient’s problem but that’s not what is being measured here. Rather, who gets to see a doctor is being taken as the measure of success because that is what is being measured - who does the doctor see?

All we require to understand this is that British GPs are not paid for seeing people. Instead they have their list and they receive an annual fee for everyone who is on that list - the capitation fee. In fact, the incentives in the British system of paying doctors are to maximise the number on the list and minimise the number of them who are actually seen. Which does, neatly, explain why the British find it so difficult to gain a doctor’s appointment, because British doctors are paid for not seeing patients.

Switch the payment system to that of other places and the performance of the system will be as that of other places. For, yes, incentives matter. Pay doctors for seeing patients and doctors will see patients. We can decry this as merely waving filthy lucre at them but given that we already stuff their mouths with gold we might as well get the incentives right as we do so.

The only useful argument against this idea is that we don’t in fact want doctors to see patients. We can imagine a bureaucracy dreaming of that as the perfect outcome but we think it more than a little odd as a goal of actual public policy.