adolf16]
Both are fair points. I'll try to address them in turn.
First, I 100% agree that it is against any physician's interest for this to happen. That is without a doubt. There is no longer autonomy when you're not running the business and you do feel pressured to do things that people in the C-suite want you to do. They might even give you bonuses for doing those things to incentivize it. But physician autonomy is out of the scope of what I was talking about, which is demand-side economics.
So patient care. Yes, some for-profit companies are a problem because people in the C-suite push their employees to do things. This is fine in sales because if you're trying to buy a car, you expect them to be pushy and try to sell you the car. But no matter what they're saying about the product, you can find ways to verify. You can look stuff up online about what you're buying to make sure that it does exactly what they claim it does. But this isn't true in healthcare due to the information asymmetry. Patients and insurers both rely on physicians to be honest when telling them what is indicated and what isn't. You can't look this stuff up most of the time - otherwise you wouldn't need to go to the doctor. You can always go for a second opinion but in many cases, people prefer to have a single provider and develop that longitudinal relationship. So this creates a problem in cases where there is physician discretion (similar to the cavities that you mention above). One of the best examples is in imaging, e.g. low value imaging for chronic back pain. In some cases this is indicated. But in many cases, it is not. One might expect that Walmart might pressure physicians to order more tests and imaging in these circumstances, especially when it starts to own more and more of the lab and imaging facilities. If you own an MRI, you obviously want to use that MRI as much as you can. So this is a form of so-called physician-induced demand.
But I personally don't think that this is inevitable. The core issue here has to do with physician ethics more so than it has to do with whether a company is for-profit or not, which was my original point. The idea is we should not train nor hire unscrupulous doctors. Obviously there will always be a few bad eggs. But this is where national benchmarking comes in. Insurers already do this for certain things. If you see a physician at Walmart ordering MRIs in 90% of his back pain patients whereas you know that the national benchmark, adjusted for region, complexity of patients, etc., is 10%, then you know you have a problem. You stop sending patients to that physician, or in this case, to Walmart. Walmart will start losing money. The idea behind benchmarking is to create a standard of care that can be enforced. Walmart would then be forced to set limits on how much the C-suite enroaches on physician autonomy, especially where it broaches ethical principles of conduct.
As a final point, I would like to point out that most non-profit hospitals are also managed by C-suite executives that are not physicians. Yes, MD/MBAs have seen a surge in recent years but they're still the minority. Most of the administrators are not MDs. I suspect that you already know this, judging from your previous post. So you'd be hard-pressed to explain why these non-physician administrators are okay but the ones over at any potential Walmart clinic are not.
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