Imagine that all bakers were nationalized under the Canada Food Act, also known as Foodiecare.

Selling bread is too important to leave to bakers.

Bakers may sell bread, but only under special rules, unknown to most customers. Customers need protection. They might buy bread they do not need.

If Sally wants bread, Bob the baker must sell only bread. If Sally wants bread and bagels, Bob must give the bagels for free or ask Sally to buy the bagels tomorrow.

Sometimes, Bob feels guilty and gives the bagels for free. Bob tells himself that he has spare time; the bagels might not sell anyways. Bob often forgets about his mal-baking insurance, continuing baking education, and saving for retirement at 73.

Canadian Bakers for Foodiecare say the cost of bagels is already priced into the average loaf of bread.

Furthermore, bakers have a privileged status under Foodiecare. People always want bread. And Canadian bakers do not have to pay for advertising and administration.

Not Eligible for Payment

In Ontario, it is illegal to bill a patient for medically necessary care if the government has decided that the care in question is “not eligible for payment”. Continue reading “Not Eligible for Payment, but Medically Necessary”

Parents and politicians share the same struggle: How do we make people behave?

The new Ontario government talks about accountability almost as much as it does about debt.

No money means no carrots, which leaves only sticks. Is leadership only carrots and sticks?

Leadership is influence. Influence comes from relationship. Successful leaders influence others toward positive ends.  As a parent/leader, how do you make your son clean his room?

You could:

Give a pep talk.

Lay down the law.

Nag.

Bribe.

Give up. He’s a boy.

Change Doctors’ Behaviour

Governments repackage these tactics to change doctors’ behaviour. Politicians often:

Give a pep talk from a famous leader on the privilege of caring.

Tighten accountabilities (Lay down the law).

Increase oversight and add behavioural prompts (Nag).

Incentivize behaviour and offer bonuses (Bribe).

Give up. Impose global cuts and offer sub-inflationary fee increases.

System leaders repackage the same rules for everything: after-hours care requirements, surgical outcomes, in-patient lengths of stay, etc. But better rules do not guarantee better patient care. Better rules make doctors focus on rules, not patients.

Rules change behaviour the way speed limits change driving habits. People perform to the limit of what goes unpunished. This Faustian deal works for speed limits. It does not work for patients. Continue reading “How to Change Doctors’ Behaviour”