Comments

• Date:

  Monday, 15 Oct ober 2007 - 16:25 UTC

  Barbara Axt said:

  nhs

• Date:

  Monday, 15 Oct ober 2007 - 20:15 UTC

  Nicolau Werneck said:

  What do you mean? You have an stomach problem, and they choose a brain surgeon to take care of you?… (That actually happens in Brazil sometimes)

• Date:

  Monday, 15 Oct ober 2007 - 22:19 UTC

  Barbara Axt said:

  hahahahaha!! Well, I never heard of such thing here. I was just mad because I can’t choose my doctor – I have to go to the one closer to my home. And if I move to other neighbourhood, I guess I have to cange doctor too (finding good doctors is always diffcult, when I like one I like to stick with this one).

  In Brazil I could choose all my doctors, specialists and all. Of course I had to pay a health plan for that but well… I’m not used to the system here and sometimes I just get really upset for not being able to make my own decisions.

• Date:

  Tuesday, 16 Oct ober 2007 - 00:42 UTC

  Nicolau Werneck said:

  Yeah, it’s difficult… But the problem is that the state must be quality-blind! Or else everyone will go for the best, because the people is not silly. It’s the same with schools. You must require people to put their kids in the local schools, or else everyone will go for this or that school because they are better, or whatever (perhaps just because a silly gossip!…)

  What if people decide they don’t want their public doctors and teachers to be tatooed, blacks, or women? It’s one thing for the private citzen to pay more to have the doctor they chose (the state might even intervene somehow), but you can’t give too much freedom in state sponsored professionals…

• Date:

  Tuesday, 16 Oct ober 2007 - 09:00 UTC

  Barbara Axt said:

  Well, I disagree. I think that way you guarantee a mediocre service for everybody (which is pretty much the purpose of some governments, I’m afraid). But you must have a way to reward the best doctors, best schools, the best teachers. And force the bad ones to try harder.

• Date:

  Tuesday, 16 Oct ober 2007 - 10:35 UTC

  Bronwen Dekker said:

  Coincidentally, the bbc has a news story saying that the ‘morale of GPs is low’.

• Date:

  Tuesday, 16 Oct ober 2007 - 17:23 UTC

  Nicolau Werneck said:

  Yes, sure you have to create some form of competition between the doctors… Otherwise they might just stand there waiting for Godot. This may come in the form of as small piece of the budget that is connected to some form of efficiency measurement, but that’s not easy. Another form this can happen is simply firing the bad doctors, but that’s a veeeery controvertial issue. There is also the problem that the doctors themselves want to choose where they want to work, for example… They can be as picky as the patients.

  When you give prizes to the best hospitals and doctors, you must be careful not to start making the rich richer. You can’t saturate the best hospitals and let the others empty because the public don’t like them for some reason. You must chose well the criterion for the bonus for the money to actually increase the general quality level.

  I saw something related to this at Nature the other day, in a story about the government support to universities in Germany… It’s the same dillemas.

  This is the sad part of being the government. Sometimes you must make everything worse for everybody, to ensure it is equalitarian… Otherwise it’s just an anarcho-capitalist society. It’s the american dream of spending as less as you can with taxes! Not the right way to go, unless you don’t have a drop of socialism running in your veins. :)