Quote Originally Posted by Husar View Post
What stops one from rewarding innovation in a non-profit system? The reward for the doctor is just another expense and not a profit. Research costs are not profit. The only thing that won't happen is that the system needs to cater to investors (sometimes perhaps even the pension funds of the patients...) who have their own ROI in mind instead of what's best for the patients.
From experience - the ethos of the system. Everyone has nice big final salary pensions. There isn't anything to gain from thinking outside the structure and there is a risk of not getting one's statutory promotion for time served.

Who in a hospital has what is best for the patient in mind? Everyone wants to get paid and get home with as little grief as possible. Whistle blowers can have their career wrecked for decades. Reporting a mistake is an admission of guilt. Keep one's head down and take the pay.

There's no need to attract patients - they have no choice but to go to the hospital regardless of what state it is in - many areas there is no other hospital and the good ones often have no ability or desire to expand. If you go bust the central government will wave a magic wand all all the debts disappear and things continue as before.