Amount

(Our conversation continued.)

After a moment of silence, L cleared his throat and said:

 “The voucher system would only work for school children because the demand of education for each kid is relatively fixed. In other words, if a child is studying in one school, it is quite impossible for him to go for another one  at the same time. Educational voucher is therefore a built-in rewarding system for schools that perform well and could attract many students. In contrast, paying a hospital – or a doctor – by the amount of clinical activity is distinctly dangerous, because the amount of medical treatment that a patient could receive is practically endless. Doctors and hospitals would be tempted to create more work for themselves and offer useless treatments.”

I saw what he meant – and was forced to agree. There are a handful of places on earth that are really running this silly system.

“Alas, my friend, I shall not be too confident with myself,” L smiled, “While I am talking to you, a brilliant idea just come through my mind – We may be able to monitor some parameters for budget allocation.”

“Really?” I was surprise.

“As you mentioned in your blog a few days ago, we should hire house officers who have a track record of AIRS. Following the same logic, we should decide the budget of each unit by its number of complications,” my friend went on, half-jokingly, “You will have more complications if you work harder and have more patients – or if you have more difficult patients. And, the beauty of this system is, the temptation of boosting up your budget would be minimal!”

For a moment, I was not sure if my friend was serious or being even more cynical than his usual - if that's at all possible.