The eternal quest of paying properly for healthcare

This editorial refers to ‘Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries’[†][1], by W. Quentin et al. , on page 1972 Probably since the first time one human being sought to improve the health status of another, in return for a material reward, there has been head scratching over how best to compensate the would-be-healer and how much. The fascinating paper by Quentin et al. on drug-related groups (DRGs) for acute myocardial infarctions in 11 European countries continues the quest.1 The most famous formal expression of concern over paying for healthcare goes back close to 4 millennia, to the Code of Hammurabi2 promulgated by the Babylonian King Hammurabi's sometime around 1700 BC. It sets forth a rudimentary malpractice code and a fee schedule for physicians—with fees varying according to the socio-economics status of the patient (see codes 215–225 in the Code of Hammurabi 3). That feature, incidentally, survives to this day in the USA, where hospital and physician fees for patients covered by the government-run Medicaid programme for the poor are significantly lower than those for the government's Medicare programme for the elderly of all socio-economic strata and for commercially insured patients, just as they were lower for patients of lower socio-economic status in ancient Babylonia. Luke 8:43 of the New Testament reports on ‘a woman having an issue of blood twelve years, which had spent all her living upon physicians, neither could be healed of any.’4 There is a hint in the language that something was wrong here with how much money physicians extracted from society. In his The Wealth of Nations , however, Adam Smith leans toward the medieval doctrine of just price5 to defend high physician incomes when he writes on the appropriate level of payment for … [1]: #fn-2