This goes for vehicle damage repairs
I got certified for auto damage appraisal.
There is a term in the business called LKQ = Like, Kind, Quality
When an insurance claim is assessed it is to restore the vehicle to LKQ. Costs are based on Manufacturer's cost assessments which is available in database. Part of the assessors job is to assess which damage is related to the incident being insured. There is a depreciation scale that is used.
No matter what the assessor submits it is up to the insurance company if they cover it. I have seen insurance companies kick back an assessment because it was too high. It delays payment to the insured and effects your reputation as an assessor.
I worked a very short period of my career in the public sector.
Most of my career was in fleet repair. In fleet repair I was an inspector. Some companies used LKQ and some did not. Most companies only wanted what was needed to safely operate the unit fixed. Others concerned themselves with keeping the units at near original conditions. Cost wise, both had advantages. The pristine fleets required less unit replacements but instead had heavy preventive maintenance, the keep it running companies had lower maintenance costs but had to replace units quicker.
As a mechanic I find truck repair similar to health care. I'm not sure if this information adds any thing to the discussion but I really enjoyed listening to my typing.
I think there is an EXCELLENT simile in this, which goes to the heart of it all. That is, that there are inescapable consequences, to the choice of approach made. It's related to what I alluded to earlier, where if we make final cost-per-unit, the only measure of medical success, the natural result will be higher "unit replacement." In the medical arena, that means that if maximizing the profits of the vendors and the insurance companies (the pure market-forces approach) is the method selected to measure success, the necessary result will be more "units" (i.e. patients) needing to be "replaced" (i.e. left to die, or simply suffer their illnesses).
When it's inanimate objects like trucks, we can shrug our shoulders and say "well, it's just a matter of which kind of paperwork you want to do." But when it's human beings, we'll be dealing with life and death. Literally.
