The Politics Of Paying American Physicians

Abstract

Paying the doctor is inherently political. Both the larger national politics of public expenditure and the narrower politics among the factions of the medical profession are involved in working out the inherent conflicts of interest between payers and the medical profession and among the medical, specialties. Fee schedules were common in every country before statutory health insurance, written by medical associa- tions or insurance carriers. To settle conflicts of interest, standing negoti- ating machinery is created. Usually the -medical associations and health insurance carriers negotiate a contract for several years at a time, defining the rights and obligations of doctors. They create a joint committee to monitor and update the fee schedule. Every year they also negotiate the financial value of the fee schedule, following cost containment guidelines from government. Before enactment of its statutory health insurance systems- Medicare and Medicaid-the United States. had many fee schedules. 1 These in- cluded the California Relative Value Studies (CRVS) and the New York Blue Shield Schedule of Allowances. Every other country has incorpo- rated such an existing fee schedule into its statutory health insurance as a matter of course. The United States did not, and Medicare has had constant trouble ever since. Med icare's Paym en t Metho d s