Zero-sum medicine

Competition appears to have mixed effects in health care. I’m reading about this topic in an interesting book about medicine in America.

Here is an interesting prediction–more than 20 years ago–as to why the game of health care changed:

Increasingly, the gains of one physician, or group of physicians, will have to come at the expense of other physicians or other providers. In the language of game theory, medical services in the 1980s will become more of a zero-sum game. New physicians…will have to take business away from someone else…

Some responses to competition may benefit patients. Doctors may hold more convenient office hours, make house calls, locate in rural areas, and take more time from their patients as they try to cultivate practice. In short, there may be a shift to greater dependence on patients, as in the nineteenth century.

But a zero-sum situation may also mean increasingly bitter competition among groups of physicians allied with different types of health care plans. It may pit established newcomers, as doctors in some communities close ranks. If they follow a protectionist strategy, established doctors may fight to curtail the spread of HMOs, to deny admitting privileges for younger colleges at local hospitals, and to maintain restrictions on licensing authority and third-party reimbursement for psychologists, optometrists, nurse practitioners, and others competing for medical expenditures.

p. 244, The Social Transformation of American Medicine

The prediction feels eerily accurate to me…

(If you’re interested, the book is written by current Princeton professor Paul Starr. It traces the changes in medical practice from the quaint doctors of the eighteenth century to the multi-millionaire surgeons of the 1980s.)