Forget the example---it's only for illustration. The argument is:
An insurance policy transforms a spiky stream of obligations into a steady stream. If priced correctly, this will make people directly pay for the risks they take, removing the element of good or bad luck. Thus giving us a much more direct link between risky behaviour and consequences.
> Do you know if the existing malpractice insurance takes into account whether a doctor follows eg checklists and stuff?
It does not. The checklist research hasn't been sufficiently replicated, and checklists do not guarantee focus and awareness. There is not a one-size-fits-all solution for increasing people's focus. The solution is not simple. The checklist researcher admits this. I wrote more in a reply to brownbat [1]
> Might not be on an individual level, but perhaps if you work for a hospital that has these procedures, one might pay less?
I suppose that'd be up to the insurer to decide whether it's profitable or not to offer an option that includes such a clause.
> In order for insurance to transmit the incentives right---and not create a moral hazard at worst---they have to have access to a lot of information.
Absolutely. As a data science guy, I'm a huge fan of more data. I also believe in the observer effect and that in the case of doctors their stress level needs to be balanced with the additional obligations we impose. Asking hospitals for more data does not necessarily translate into better care.
"Doctors need to be able to work one-on-one with their patients, without the added pressure of survey scores and ratings that have little insight into the entire patient experience" [2]
Convincing doctors to provide more data is critical in the process of data collection. That process is probably best begun by a significant effort to understand the doctors' hardships and workflows.
I suspect people have tried but do not have time to interview every doctor. Even then, you will never get everyone to agree. So it's a matter of working with whatever data we have, supporting good doctors and practices, and crossing our fingers that we haven't overlooked some practice that worked better in the past.
> I suppose that'd be up to the insurer to decide whether it's profitable or not to offer an option that includes such a clause.
Alas, insurers are not included to discriminate on arbitrary things. Ie even if male doctors had statistically a higher chance of malpractice than female doctors, I doubt the laws would allow the premiums to reflect that?
For sure you can't discriminate based on protected classes such as race or sex. I think that's a good thing even if in the short term it led to more accurate premiums. There is nothing about a human's race or sex, etc that predisposes them to being a bad doctor. Even if data showed that men make more mistakes than women, there'd still be plenty of individual men who don't. So basing rates on that data would be discriminatory and bad for society.
I think this gets trickier when you look at health insurance for individuals. My google research tells me that under ObamaCare you can't be charged more for being unhealthy, but that you can be charged more for smoking. I suppose the logic goes there that quitting smoking is easier than telling your defective heart to be healthy. A smoking addiction is relatively more under your control than some other health conditions.
Thanks for the discussion! I've learned a lot from trying to do research and formulate my own views about healthcare in this thread.
It's an argument based on a made up or uncited statistic.