“Show me the incentive and I’ll show you the outcome”
Charlie Munger, sócio de Warren Buffett e vice chairman da Berkshire Hathaway,
Os hospitais americanos estão provavelmente a reportar mais casos de mortes por covid-19 do que o que seria normal.
Não por teorias de conspiração. Mas por simples incentivo económico enviezado, provocado pelas políticas públicas.
Sabemos que uma grande parte das vítimas apresenta diversas patologias, sendo a covid-19 uma delas. Qual a que os hospitais preferem colocar nos certificados de óbito, em caso de dúvida? A que lhes render mais dinheiro.
A Medicare paga $5.000 por cada internamento por pneumonia. Mas se fôr classificado como pneumonia por covid-19, paga $13.000; e se fôr ligado a um ventilador, $39.000.
Artigo da excelente Frontier for Economic Education.
Cito:
Earlier this month, Illinois’s top health official explained that any victim diagnosed with the novel coronavirus would be classified as a COVID-19 death—regardless of whether it contributed to the patient’s death.
“If you died of a clear alternate cause, but you had Covid at the same time, it’s still listed as a Covid death,” Dr. Ngozi Ezike, the director of Illinois’s Department of Public Health,
Not all states have taken an approach as direct as Illinois’s, but even where state guidelines don’t call for listing the mere presence of COVID-19 as the cause of death, it appears hospital administrators are taking a proactive role.
As Minnesota lawmaker and longtime family practitioner Dr. Scott Jensen recently observed, hospitals are incentivized to pressure physicians to include COVID-19 on death certificates and discharge papers, since the CARES Act increases Medicare payments to hospitals treating COVID-19 victims.
Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate. Why? Because if it’s a straightforward, garden-variety pneumonia that a person is admitted to the hospital for—if they’re Medicare—typically, the diagnosis-related group lump sum payment would be $5,000,” said Jensen, whose claim was fact-checked by USA Today. “But if it’s COVID-19 pneumonia, then it’s $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000.
The idea that physicians would be pressured to list COVID-19 on death certificates even when it appears the virus had little or nothing to do with someone’s cause of death might sound crazy, but some would say it was entirely predictable.
The economic incentive is clear and does not require any conspiracy.