The caregivers were encouraged to describe the episode from beginning to end in their own words, and were, during this illness narrative, prompted to describe decision-making processes, perceived causes, provider preferences, medical costs and perceived quality of care [ 23].
But questions remain, including whether the investigation may have also caused providers to avoid implanting the devices in patients who need them.
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.
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.
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].
