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Personal View: When collaboration beats competition in health care

Although marginally helpful, none of these deal with the underlying issues in health care. The big question is how physicians choose what care to recommend and provide and what results from their choices in terms of costs and outcomes. Since, by definition, the doctors know more about medical care than we do as consumers, it is difficult to believe that we can outguess them by selecting care alternatives in a competitive marketplace. We want them to know more and we are willing to pay them for this knowledge. So the real question is how can we change the way physicians practice to advance toward the triple aim of improved quality, better outcomes and reduced per capita cost?

It’s not as if physicians don’t value these goals. The natural bent of physicians starting with their medical school training is toward collaboration and peer review. Difficult cases call for a consult, and residents rely on oversight from faculty.

But this natural desire to gather all sources of knowledge that might be helpful for each patient is more difficult when salaried physicians work for competing organizations and practices. Referral out of a health system may be discouraged or even prohibited if the patient is insured within a narrow network. But beyond contractual issues, it may be hard for physicians to talk to other physicians across dispersed practice settings as primary care, and even specialty practices, are devolved into neighborhoods rather than located together in a medical center.

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