[The bitter pay back--perverse financial incentives in healthcare]

This article analyses the stimuli that arise from the current design of the healthcare system. Hospital care is fragmented into an endless series of interventions and subsidiary interventions that are parts of chains, lines of care, care trajectories and care protocols. Each intervention has its own logic and quality standards. And each of these interventions not only bears an estimate of the intensity of care but increasingly a price tag as well. These interventions are vitally important because they form the basis for the declarations of costs. Consequently this set-up provides a perverse incentive that elicits greed and meanness. Three factors underlying this are discussed in this article: a meritocratic culture, Taylorism in the care process and misplaced market thinking.