Reimbursement is a major determinant of how medicine is practiced. When reimbursement changes, so do medical practice and medical education.

Dean Ornish’s quote highlights the significant influence that reimbursement plays on the way medicine is practiced. In the context of healthcare, reimbursement refers to the payment that healthcare providers receive from insurance companies or government programs for the services they provide to patients. Ornish emphasizes that reimbursement doesn’t just impact the financial side of medicine—it also shapes how doctors practice medicine and how medical education is structured. Changes in reimbursement rates or policies can lead to shifts in the types of care that are prioritized and the methods by which care is delivered.

The quote implies that when reimbursement policies change, healthcare providers are often forced to adapt their practices to align with the new financial incentives. For example, if certain treatments are reimbursed at higher rates than others, providers might focus more on those areas of care, even if other treatments might be equally or more beneficial for patients. Similarly, medical schools might alter their curricula to emphasize areas that align with the highest reimbursement potential, influencing the training future doctors receive.

Ornish also touches on how these financial pressures can sometimes conflict with the best interests of patients. When reimbursement is tied to volume—meaning healthcare providers are paid more for seeing more patients or performing more procedures—it can lead to a system where quantity of care is prioritized over quality. This dynamic can influence how doctors approach patient care, potentially leading to less time spent on individualized care or preventive medicine, which may not be reimbursed as effectively.

The origin of this quote likely stems from Ornish’s career as a physician and researcher in preventive medicine, where he has long advocated for changes to the way healthcare is delivered. As a proponent of more holistic and preventive approaches to medicine, Ornish has seen firsthand how the financial structures of healthcare—such as reimbursement policies—can influence the way healthcare providers deliver care, sometimes in ways that don't always align with the long-term health needs of patients. His work emphasizes the need for systemic changes to improve health outcomes by addressing both the financial incentives and the educational framework that shape the medical field.