[elwebmaster]

How about this one:

- patient: wants to maximize care, money no object since it isn't theirs

- medical practice: wants minimize care since money is based on number of patients not care

- insurer (government): wants to minimize money spent on care while maximizing care because money comes from healthy citizens who pay taxes

[renewiltord]

There are two differently behaving conforming things in reality of these I think. Both Medicare and the UK/CA NHS in my knowledge conform to your description.

In Medicare, this incentivizes maximizing patients on 'recurring revenue procedures' like dialysis.

In the UK NHS (which I know better), it leads to the government denying certain kinds of care depending on the Adjusted QALYs / pound spent that the intervention will provide.

TANSTAAFL after all, but yes, perhaps the interesting thing about the government being in that model is that patients can control government in a way that they cannot control insurance companies (i.e. they're not strictly oppositional) and consequently when the insurer is the government you get spend-bias in the direction of who has government power. In the US, that turns out to be old people. Additionally, governments have non-health-related sources of revenue so a government health plan can be used as a redistribution mechanism.

But I think it leads to these outcomes predictably with a splitter placed on how much control the government exerts over the practice and how much control the patients exert on the government.