PHYSICIANS
QUESTIONS
I. How are physicians paid?
. Which types of physicians earn the highest incomes?
3. How much does it cost to practice medicine? 4. Are malpractice insurance premiums a major cause of higher doctor bills?
5. Is medical care sold like other goods and services? 6. Who chooses which treatment to use, the patient or the doctor?
7. Why are licensure restrictions more strongly enforced for some types of medical care than for others?
8. Is the American Medical Association (AMA) a professional society serving science or a union serving the economic interests of its members? Is it both?
9. Which is more competitive: the market for health insurance or the market for medical care?
At the center of medical practice stands the physician. Physicians direct the flow of patients by controlling admissions, referrals, regulations, insurance reimbursements, and prescriptions. A very powerful and special bond exists between doctor and patient. This relationship is based on medical science—and ethics and emotions—as well as economics) Even when a transaction does not directly involve a physician financially, the physician still plays a dominant role. In the preceding chapters we discussed health care from the perspective of the patient. Now we switch to the perspective of the provider: not the payer but the payee. For the physician, medical expenditures are not costs, they are revenues.
6.1 FINANCING PHYSICIAN SERVICES: REVENUES
Whereas most of the labor force is employed and paid a salary by a large organization, many physicians are independent entrepreneurs or partners running what are, in effect, small busi-nesses.’
The income of physicians in solo or group private practices mostly comes from fee-for-service payments, a specified amount paid for each visit or procedure, although an increasing amount is coming from complex, negotiated third-party contracts.
In the 1930s, physicians were essentially free to charge whatever they decided was appropriate but they often collected much less than what they charged. Today, 89 percent of physician revenues come from third-party payments,3 and most fees are subject to some form of external review’or control (see box “Types of Physician Payment”).
Part 1.
Discuss statistics on physician incomes using Table 6-3. Explain how the Medicare RBRVS reimbursement system was designed to rebalance incomes across specialties and provide more payment for thinking and caring.
Part 2.
Discuss pending Medicare fee restructuring under the ACO, bundled payment, and the ACO, what’s different? How will these changes impact health care delivery and access?
Primary post must include references and in-text citations to give credit to your sources. One of your references must be the textbook:
Getzen, Thomas E. (2013). Health Economics and Financing. 5th ed. John Wiley & Sons Publishing. ISBN-10: 1-118-18490-4 or ISBN-13: 978-1-118-18490-5
