Paying Several Physicians for Treating an Episode of Illness

摘要

Fee-for-service reimbursement of physicians has been argued to have contributed to the growth in expenditures for physician services in the last three decades. Projected to reach over $141 billion by 1990, this component of health care expenditures went from $2.7 billion in 1950 to over $70 billion in 1983, due not only to general inflation, population growth, and demographic changes, but also to changes in medical care, such as increased patient visits per capita and changes in the type and complexity of medical services and associated technology. In the public sector, this inflation in medical costs is reflected by a fourfold increase in public expenditures for physician services, from 7 percent of all physician expenditures in 1965 to 28 percent in 1983 (Freeland and Schendler, 1983). Third party reimbursement by either private insurers or federal, state, and local agencies have shielded most patients from the true costs of care; fee-for-service reimbursement systems have lacked incentives to provide care at the lowest possible cost. Findings are based on estimates of the percent and characteristics of the population with episodes of illness not requiring inpatient care in 1977 and the mean number of such episodes per capita. The number of physicians providing services to patients receiving only ambulatory care in an episode of illness (i.e., an ambulatory condition package) was established, as was the percent of total charges reimbursed to physicians in such episodes according to the number of physicians providing care.