Abstract
Several current and proposed structural features of medical reimbursement are intended to alter the behavior of health care providers. I propose adding a structure to make physician behavior more ethical. The structure's design would be complex, but its core would be reminiscent of how a patron tips waiters. My proposal would apply the truism that society's reward systems should foster rather than undermine social goals. This idea draws on features of medicine's social background and on a theory of behavior. It challenges the taboo against the physician's financial interests being clearly present in the doctor-patient relationship and it challenges the overly pure characterization of medical ethical dilemmas that currently dominates. Detailed sketches of necessary mechanisms, such as anonymous forms for patients to complete, are offered, and connections to the insights of George Bernard Shaw are made.
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