RESUMEN
As health care finance has changed from a system of cash from patients to third-party reimbursement, a variety of mechanisms have been devised to bring equity to the payment process. The latest payment mechanism for this purpose is the resource-based relative value scale system implemented by Medicare, which is now being adopted by other third-party payers. However, too many payers are pushing for discounts from providers at the point of adoption of the system, thus foiling the equity aspect of the system.
Asunto(s)
Medicare Part B , Escalas de Valor Relativo , Estados UnidosRESUMEN
In response to pressures on the practice of medicine, new practice management styles and organizations are being created to meet market demands. Managed care environments have encouraged the development of IPAs, closed panel HMOs, and other corporate structures to provide care for their patients. Early resistance of physicians to joining in administrative arrangements has now melted. Providers are beginning to adopt the philosophy of joining resources for survival and to improve market penetration. Physician executives must keep their minds open to the possibility that these provider-based organizations will occur even in the most unlikely places.
Asunto(s)
Asociaciones de Práctica Independiente/organización & administración , Administración de la Práctica Médica/tendencias , Asociaciones de Práctica Independiente/tendencias , Indiana , Médicos de Familia/economía , Médicos de Familia/provisión & distribución , Administración de la Práctica Médica/economíaRESUMEN
In this era of managed care, the message has been that the health care industry has provided inappropriate or inefficient care, causing the ruination of medicine and ultimately of the U.S. economy. Published research data on small area analysis have demonstrated marked differences in utilization rates for the same surgical procedure in various locations. Researchers and others have logically surmised that criteria used by providers in recommending these procedures have also varied from location to location. Correction, therefore, will require attention to the establishment of logical and defensible criteria.
Asunto(s)
Investigación sobre Servicios de Salud/normas , Servicios de Salud/estadística & datos numéricos , Estudios de Evaluación como Asunto , Hospitales/estadística & datos numéricos , Análisis de Área Pequeña , Estados Unidos , Revisión de Utilización de RecursosRESUMEN
It has been pointed out by advocates of change in the U.S. health care delivery system that, with the exception of the Republic of South Africa, the United States is the only industrialized nation without a system of national health care. Rising costs and an increasing percentage of Americans without insurance and with limited access to health care services has heightened interest in the development of a mechanism for payment for health care services in this country.
Asunto(s)
Política de Salud/tendencias , National Health Insurance, United States/economía , Indigencia Médica , Estados UnidosRESUMEN
After years of attempting to control costs by changing providers' behavior and practice patterns, it has become apparent that the solution lies in the study and cooperation of practitioners. Computers, reports, analysis, and payment reforms have discovered the truth: Many physicians and hospitals have always provided high-quality care efficiently. Costs will be controlled when these providers dominate the health care delivery system.
Asunto(s)
Habilitación Profesional/economía , Cuerpo Médico de Hospitales/normas , Pautas de la Práctica en Medicina/economía , Terapia Conductista/métodos , Control de Costos , Humanos , Estados UnidosRESUMEN
Beginning with this issue of Physician Executive, members of the Society on Insurance of the American College of Physician Executives will provide an ongoing column for readers on the unique point of view of the health care insurer. The column starts with an offering by the Chairman of the Society on the physician executive's role in resolving the anomalies of the health care payment system.