Bayesian Investor Blog

Ramblings of a somewhat libertarian stock market speculator

Medical Tourism Seasteads

Posted by Peter on October 28, 2009
Posted in: Freedom, Health. Tagged: seasteading.

How can a hospital-like business operating outside of existing territorial jurisdictions avoid harrassment by governments whose medical lobbies want to spread FUD?

Given that these businesses will initially have no track record to point to and less protection than existing medical tourism providers from whatever government provides a flag of convenience to the business, merely providing comparable quality medical care won’t be enough for such businesses to thrive. So I’m proposing practices which could enable those businesses to argue that current U.S. hospitals are more dangerous. I’m not suggesting this just for marketing purposes – I want safe hospitals to be available, and regulatory costs in the U.S. make it easier to start an innovative hospital offshore than in the U.S. (especially for types of innovation that don’t respect doctors’ prestige).

It has been known since 1847 that doctors kill patients by failing to wash their hands often enough. Yet this threat is still common. An offshore hospital could offer patients documentation showing when medical personel who touch the patient washed their hands (e.g. by providing the patient with video recordings of the procedures sufficient for the patient to verify cleanliness), with a double your money back guarantee. There are many other less common errors that patients could use such videos to check for.

The book Counting Sheep argues that hospitals often impair patients’ health by disturbing their sleep. Paying patients if night-time noise or light levels exceed some pre-specified limits should reduce this problem.

Next, I want the hospital’s fee structure to give it increased incentives to avoid failure. For procedures with objectively measurable results, I want the hospital to charge the patient only if those results are achieved, and to pay the patient some pre-specified amount if results leave the patient measurably worse off. (For hard to measure results such as change in pain, this approach won’t work).

The article You Get What You Pay For: Result-Based Compensation for Health Care has more extensive discussion of incentives and of strategies that hospitals might use to reduce the rate at which they harm patients.

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