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Perverse Incentives, Statesmanship, and the Ghosts of Reforms Past

Peter E. Dans, MD, Deputy Editor
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Annals of Internal Medicine, Philadelphia, PA 19106. Requests for Reprints: Peter E. Dans, MD, American College of Physicians, Sixth Street at Race, Philadelphia, PA 19106.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(3):227-229. doi:10.7326/0003-4819-118-3-199302010-00015
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We are on the verge of health care reforms aimed at increasing access for the uninsured while decreasing costs. Such reforms will require better integration and deployment of health care personnel and facilities. This will be difficult given the perverse incentives (in many cases, the residues of past reforms). Mirroring societal values, these incentives have resulted in a system skewed toward technologic and subspecialty solutions rather than preventive, primary, and long-term care. If the promise of this reform movement is to be realized, statesmanship will be required at all levels by all concerned.



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