Nicotine has real harms, but they pale in comparison to tobacco smoke. Cigarette continuity programs and social support for smoking. American Family Physician. Practice Incentives Much has been written about the messy tangle of incentives in which physicians practice medicine. I believe that the key problem is the traditionally adversarial relationship between insurers and patients.
Patients change insurers too often for the insurer to reap the benefits of preventive care.
Insurers have little direct incentive to preserve life, but this is of paramount importance to most patients. Insurers are also the only health care players with the financial and data resources required to develop incentive systems that reward doctors for high quality care, but the insurer must be rewarded for developing the incentives. At least two insurance company structures have the potential to reconcile patient and insurer incentives, so that insurers might make the investments required to improve health care delivery. First and best, health care cooperatives are in effect owned by the patients. As owners, the patients are presumably less likely to leave the insurer.