Sunday, April 28, 2013

Hammurabi’s Code and U.S. Health Care

Interesting that the economist, Uwe Reinhardt, opted for citation of eye surgery in this article!
There are also some good letters to the editor at the end of the article... (hit the link button below)

Sometime around 1780-70 B.C., the Babylonian King Hammurabi promulgated the now famous Code of Hammurabi, covering both civil and criminal law.
Perspectives from expert contributors.
The code is said to have informed both Jewish and Islamic law. Remarkably, it has echoes also in modern health policy in the United States.
Among the 282 laws in Hammurabi’s Code, nine (215 to 223) pertain to medical practice:
215. If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive 10 shekels in money.
                216. If the patient be a freed man, he receives five shekels.

Not all of these laws have survived the millennia. Relative to Hammurabi’s draconian medical malpractice code, for example, modern medical malpractice penalties represent mere slaps on the wrist.
On the other hand, our modern, differentiated payment system for health care does resemble the Code of Hammurabi in some respects.
To illustrate, for a primary care office visit with a new patient of 30-minute duration (using Current Procedural Terminology, or C.T.P. codes, in this case Code 99203), New Jersey’s Medicaid in 2012 paid a nonspecialist $25 and a board-certified specialist $32.30. The comparable fees paid physicians for commercially insured patients are jealously guarded trade secrets, but it is reasonable to assume them to be $100 to $200. Other fees in the C.P.T. code are similarly low for Medicaid.
Physicians clearly understand this relative valuation being signaled to them. According to a recent estimate, almost a third of American physicians are unwilling to accept any new patients covered by Medicaid. In New Jersey in 2011, only 40 percent of physicians accepted new Medicaid patients (seeExhibit 4). Given the insulting valuations many state Medicaid programs put upon the physicians’ work, that’s understandable.

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