Work in healthcare and while there are just so many dark sides a big one that’s not talked about enough:

The foundational model for our healthcare system is called fee for service medical billing. This means what it says, a fee is payed for a service.

I work in mental health so for me it works like this: I see you for 53 minutes, I can bill for an hour of psychotherapy service, cpt 90837 which gets me paid a certain amount. But let’s say you are not able to effectively communicate and need a third party to assist in your communication. I need to read your non verbal language and decipher any utterances you make while also communicating with this third party who acts as a liaison for you. I can add code 90785, interactive complexity.

This is a limited example because outpatient mental ultimately has a limited amount of billing codes. But if I am an orthopedic surgeon all of a sudden I have thousands of billing codes to utilize. Now I might pull a splinter from your hand and pad this bill with 19 services. Many doctors, especially in large healthcare networks, have either no idea this is even happening (billing is generated from their notes) or they are heavily pressured to do this by owners that are increasingly profit driven

This is not to suggest mental health is exempt because of a lack of billing codes either. You may be doing fine. Or I may have reached the limit of what I can offer you with my skill set. Yet I still schedule appointments with you week after week after week because you consistently show up. I need a paycheck, a great deal of mental health workers are contract employees that are only paid when they actually render a service, they aren’t paid nearly as well as you think, and they get no benefits whatsoever

This illustrates the point I am making. Fee for service billing encourages dishonesty and unethical practice. Other countries that utilize it have similar issues and when they adopt it they see healthcare costs and utilization begin to rise rapidly. China is transitioning away from the fee for service model for this reason. Unfortunately transitioning away is difficult because both healthcare networks and practitioners are incentivized to fight to keep it. Pay for performance, diagnosis related groups, etc reduce healthcare spending (sometimes substantially) but any time healthcare spending is reduced earning potential for healthcare networks and practitioners is threatened so there will be pushback