What Doctors Want: A Comment on the Financial Preferences of Organized Medicine

2021 ◽  
Author(s):  
Isabel M. Perera
Keyword(s):  
Health Care ◽  
Comparative Studies ◽  
Fee For Service ◽  
Payment Systems ◽  
Health Politics ◽  
Relevant Today ◽  
Organized Medicine ◽  
Advanced Democracies

Abstract Organized medicine’s persistent demand for high payments is one factor that contributes to the rising costs of health care. The profession’s longstanding preference for private and fee-for-service practice has pressured payers to increase reimbursement rates in fee-based systems; and it has stalled, thwarted, or otherwise co-opted attempts to contain costs in other payment systems. Yet what doctors want in fact varies. This comment revisits classic comparative studies of organized medicine in the advanced democracies to highlight two underemphasized findings: (1) physicians’ financial preferences can deviate from traditional expectations, and (2) the structure of the organizations that represent doctors can shape whether and how those preferences are expressed. These findings remain relevant today, as a discussion of contemporary American health politics illustrates.

scholarly journals Competition Policy And Organizational Fragmentation In Health Care

2009 ◽  
Vol 71 (2) ◽  
Author(s):  
Thomas (Tim) Greaney
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Moral Hazard ◽  
Delivery System ◽  
Competition Policy ◽  
Good Time ◽  
Market Forces ◽  
Fee For Service ◽  
Antitrust Enforcement ◽  
Payment Systems

Once upon a time . . . and a very good time it was, advocates for marketbased approaches to health policy had a coherent story to tell. Cost and quality would remain suboptimal as long as fee-for-service medicine persisted and the myriad market imperfections that impede efficiency went unchecked. However, things could be righted by adopting principles associated with managed care, together with pursuing sensible antitrust enforcement and government deregulation to clear away the private and regulatory underbrush obstructing market forces. Economic theorists and policy experts agreed that these steps would effectively address information, agency, and moral hazard problems and begin to glue together the pieces of our fragmented delivery system. And, for a while, things seemed to work out as promised. Providers began to reorganize into firms and other integrating arrangements and health insurers adopted financial and contractual measures designed to align provider incentives with consumer needs. Regulators directed policies at removing obstacles to competition and antitrust enforcers sought to encourage efficient consolidation while blocking cartels and provider oligopolies. Spiraling costs leveled off for a while and both payment systems and provider organizations began to adapt to market forces.

Republished: Big Things Come in Bundled Packages: Implications of Bundled Payment Systems in Health Care Reimbursement Reform

2019 ◽  
Vol 34 (5) ◽  
pp. 482-487 ◽  
Author(s):  
Dennis R. Delisle
Keyword(s):  
Health Care ◽  
Quality Care ◽  
Clinical Settings ◽  
Fee For Service ◽  
Payment Systems ◽  
High Quality ◽  
Bundled Payment ◽  
High Quality Care ◽  
Bundled Payments ◽  
Daunting Task

With passage of the Affordable Care Act, the ever-evolving landscape of health care braces for another shift in the reimbursement paradigm. As health care costs continue to rise, providers are pressed to deliver efficient, high-quality care at flat to minimally increasing rates. Inherent systemwide inefficiencies between payers and providers at various clinical settings pose a daunting task for enhancing collaboration and care coordination. A change from Medicare’s fee-for-service reimbursement model to bundled payments offers one avenue for resolution. Pilots using such payment models have realized varying degrees of success, leading to the development and upcoming implementation of a bundled payment initiative led by the Center for Medicare and Medicaid Innovation. Delivery integration is critical to ensure high-quality care at affordable costs across the system. Providers and payers able to adapt to the newly proposed models of payment will benefit from achieving cost reductions and improved patient outcomes and realize a competitive advantage.

Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine

2021 ◽  
pp. 155982762110066
Author(s):  
Amy R. Mechley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
The United States ◽  
Fee For Service ◽  
Financial Model ◽  
Lifestyle Medicine ◽  
Direct Primary

Primary care has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.

HEALTH TECHNOLOGY ASSESSMENT IN THE NETHERLANDS

2000 ◽  
Vol 16 (2) ◽  
pp. 485-519 ◽  
Author(s):  
Michael Bos
Keyword(s):  
Health Care ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Private Insurance ◽  
National Level ◽  
Health Technology ◽  
Care Quality ◽  
High Tech ◽  
Fee For Service ◽  
Equal Distribution

The Dutch healthcare system is not a single overall plan, but has evolved from a constantly changing mix of institutions, regulations, and responsibilities. The resulting system provides high-quality care with reasonable efficiency and equal distribution over the population. Every Dutch citizen is entitled to health care. Health insurance is provided by a mix of compulsory national insurance and public and private insurance schemes. Hospitals generally have a private legal basis but are heavily regulated. Supraregional planning of high-tech medical services is also regulated. Hospitals function under fixed, prospective budgets with regulation of capital investments. Independent general practitioners serve a gatekeeper role for specialist and hospital services and are paid by capitation or fee for service. Specialists are paid by fee for service. All physicians' fees are controlled by the Ministry of Economic Affairs. Coverage of benefits is an important method of controlling the cost of services. There is increasing concern about health care quality. Health technology assessment (HTA) has become increasingly visible during the last 15 years. A special national fund for HTA, set up in 1988, has led to many formal and informal changes. HTA has evolved from a research activity into policy research for improving health care on the national level. In 1993 the government stated formally that enhancing effectiveness in health care was one of its prime targets and that HTA would be a prime tool for this purpose. The most important current issue is coordination of HTA activities, which is now undertaken by a new platform representing the important actors in health care and HTA.

scholarly journals Association of Declines in End-of-Life Health Care Costs With Fee-for-Service Enrollee Per Capita Expenditures

2020 ◽  
Vol 3 (3) ◽  
pp. e200861
Author(s):  
William B. Weeks ◽  
Stacey Y. Cao ◽  
Chris M. Lester ◽  
James N. Weinstein
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Costs ◽  
Fee For Service ◽  
Per Capita ◽  
Care Costs
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