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Concern about those regrets, enthusiasm about IUDs, and the general irreversibility of tubal ligation cause providers such as Gunter to challenge women who think they want the procedure.
Dr McClellan reckons that competition for participants, combined with more price transparency thanks to the internet, will cause providers to drive hard bargains.
For example, women and adolescent girls may have, in theory, access to contraception, but norms around their gender or age may cause providers to deny access without the consent of a spouse or parent.
These factors may cause providers to spend more time on, or have more frequent encounters with, certain patients, making it more difficult for them to provide quality care [ 37].
As a result of explicitly targeting specific aspects of care, P4P incentives may cause providers to focus disproportionately on those aspects of care that are measured and incentivized, possibly to the detriment of other, often more indeterminate aspects that are not (easily) measured [ 38, 55].
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A fundamental question about public reporting is whether it causes providers to select healthier patients for treatment.
But questions remain, including whether the investigation may have also caused providers to avoid implanting the devices in patients who need them.
When this causes providers to become temporarily understaffed, they may lose child care slots due to mandated ratios.
But that often backfires, causing providers unable to reach you to send your account to collections, which can then damage your credit.
The switch from a predominantly fee-for-service system to value-based reimbursement has turned the traditional model of healthcare reimbursement on its head, causing providers to change the way they bill for care.
PCMH efforts to reorganize processes of care and improve productivity through technological innovations may have unintended consequences by actually creating additional work or causing provider dissatisfaction particularly if providers do not have the opportunity to influence practice redesign efforts [ 54].
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