Payment reform: parlous, and yet still promising.

摘要

This issue of Health Affairs on payment reform has a hoary pedigree, given the years of thought devoted to economic incentives in health care. The British literary giant George Bernard Shaw long ago grasped the dubious effects of fee-for-service medicine: In the preface to his 1909 play The Doctor's Dilemma, he lamented the payment norm that gave "a surgeon a pecuniary interest in cutting off your leg... and the more appalling the mutilation, the more the mutilator is paid." The Hoover-era Committee on the Costs of Medical Care also partly blamed fee-for-service for that era's health cost spiral. The panel suggested "group payment" of physicians as an alternative, but in a nod to political realities, also contended that "those who prefer the present method" of payment should be able to keep what they had.