In this article from Healthcare Papers, AIMS Fellow in Health Policy Dr. David Zitner continues to engage his colleagues in a discussion of the inherent bias in a system where insurer also acts as regulator. In looking at the work of another fellow pioneer in this area, George Browman, Zitner finds further compelling evidence that the system is in need of fundamental change.

In health care good deeds are punished, not rewarded. Canadian governments fail to regulate health care because of the conflict of interest arising when the same group not only regulates care but also functions as insurer, governor, administrator and evaluator.

We need radical change to eliminate the perverse incentives and bizarre management practices that bedevil our health care system, and impede the use of evidence based decision making. Separating the functions of insurer, administrator, evaluator and regulator is ethical and necessary.

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