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September 28, 1994, Vol 272, No. 12 >
ARTICLE | September 28, 1994

Reimbursing Physicians and Hospitals FREE

Thomas Bodenheimer, MD, MPH; Kevin Grumbach, MD
[+] Author Affiliations

Edited by Drummond Rennie, MD, Deputy Editor (West).

Address correspondence to Box 1364, University of California—San Francisco, San Francisco, CA 94143-1364 (Dr Grumbach).


JAMA. 1994;272(12):971-977. doi:10.1001/jama.1994.03520120081038
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References

The first article in this series described the different modes of financing health care—out-of-pocket payments, individual health insurance, employment-based health insurance, and government financing. Each of these payment mechanisms attempted to solve the problem of unaffordable care for certain groups in the population, but each in turn created new problems by stimulating rapid rises in health care costs. The method of reimbursement of physicians and hospitals contributed to health care inflation; thus, a change in how health care providers are paid is currently being promoted as a solution to the cost problem.

Dr Mary Young recently finished her family practice residency and joined a small group practice, PrimaryCare. On her first day, her first patient was insured by Blue Shield; PrimaryCare was paid a fee for the physical examination and for the electrocardiogram (ECG) performed. Dr Young's second patient required the same services, for which PrimaryCare received no payment but

REFERENCES

1 +
Lee PR, Grumbach KL, Jameson WJ.  Physician payment in the 1990s: factors that will shape the future. Annu Rev Public Health . 1990;;11:297-318.
2 +
Iglehart JK.  Health policy report: the American health care system: managed care. N Engl J Med . 1992;;327:742-748.
3 +
Langwell KM, Nelson LM.  Physician payment systems: a review of history, alternatives and evidence. Med Care Rev . 1986;;43:5-58.
4 +
Jencks SF, Dobson A.  Strategies for reforming Medicare's physician payments. N Engl J Med . 1985;;312:1492-1499.
5 +
Lee PR, Ginsburg PB, LeRoy LB, Hammons GT.  The Physician Payment Review Commission report to Congress. JAMA . 1989;;261:2382-2385.
6 +
Relman A.  The future of medical practice. Health Aff (Millwood) . 1983;;2( (2) ):5-19.
7 +
Grumbach K, Fry J.  Managing primary care in the United States and in the United Kingdom. N Engl J Med . 1993;;328:940-945.
8 +
Welch WP, Hillman AL, Pauly MV.  Toward new typologies for HMOs. Milbank Q . 1990;;68:221-243.
9 +
Cook JV, Rodnick JE.  Evaluating HMO/IPA contracts for family physicians: one group's experiences. J Fam Pract . 1988;;26:325-331.
10 +
Day P, Klein R.  Britain's health care experiment. Health Aff (Millwood) . 1991;; 10( (3) ):39-59.
11 +
Hillman AL.  Managing the physician: rules versus incentives. Health Aff (Millwood) . 1991;;10( (4) ):138-146.
12 +
Marder WD, Emmons DW, Kletke PR, Willke RJ.  DataWatch: physician employment patterns: challenging conventional wisdom. Health Aff (Millwood) . 1988;;7( (5) ):137-145.
13 +
Scovern H.  A physician's experiences in a for-profit staff-model HMO. N Engl J Med . 1988;;319:787-790.
14 +
Law SA. Blue Cross: What Went Wrong? New Haven, Conn: Yale University Press; 1974;.
15 +
Melia EP, Aucoin LM, Duhl LJ, et al.  Competition in the health-care marketplace: a beginning in California. N Engl J Med . 1983;;308:788-792.
16 +
Iglehart JK.  Medicare begins prospective payment of hospitals. N Engl J Med . 1983;;308:1428-1432.
17 +
Hornbrook MC, Scheffler RM, Rossiter LF, eds. Risk-Based Contributions to Private Health Insurance: Advances in Health Economics and Health Services Research, XII . Greenwich, Conn: Jai Press; 1991;.
18 +
Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach . Norwalk, Conn: Appleton and Lange; 1995;.
19 +
Casalino LP.  Balancing incentives: how should physicians be reimbursed? JAMA . 1992;;267:403-405.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Lee PR, Grumbach KL, Jameson WJ.  Physician payment in the 1990s: factors that will shape the future. Annu Rev Public Health . 1990;;11:297-318.
2 +
Iglehart JK.  Health policy report: the American health care system: managed care. N Engl J Med . 1992;;327:742-748.
3 +
Langwell KM, Nelson LM.  Physician payment systems: a review of history, alternatives and evidence. Med Care Rev . 1986;;43:5-58.
4 +
Jencks SF, Dobson A.  Strategies for reforming Medicare's physician payments. N Engl J Med . 1985;;312:1492-1499.
5 +
Lee PR, Ginsburg PB, LeRoy LB, Hammons GT.  The Physician Payment Review Commission report to Congress. JAMA . 1989;;261:2382-2385.
6 +
Relman A.  The future of medical practice. Health Aff (Millwood) . 1983;;2( (2) ):5-19.
7 +
Grumbach K, Fry J.  Managing primary care in the United States and in the United Kingdom. N Engl J Med . 1993;;328:940-945.
8 +
Welch WP, Hillman AL, Pauly MV.  Toward new typologies for HMOs. Milbank Q . 1990;;68:221-243.
9 +
Cook JV, Rodnick JE.  Evaluating HMO/IPA contracts for family physicians: one group's experiences. J Fam Pract . 1988;;26:325-331.
10 +
Day P, Klein R.  Britain's health care experiment. Health Aff (Millwood) . 1991;; 10( (3) ):39-59.
11 +
Hillman AL.  Managing the physician: rules versus incentives. Health Aff (Millwood) . 1991;;10( (4) ):138-146.
12 +
Marder WD, Emmons DW, Kletke PR, Willke RJ.  DataWatch: physician employment patterns: challenging conventional wisdom. Health Aff (Millwood) . 1988;;7( (5) ):137-145.
13 +
Scovern H.  A physician's experiences in a for-profit staff-model HMO. N Engl J Med . 1988;;319:787-790.
14 +
Law SA. Blue Cross: What Went Wrong? New Haven, Conn: Yale University Press; 1974;.
15 +
Melia EP, Aucoin LM, Duhl LJ, et al.  Competition in the health-care marketplace: a beginning in California. N Engl J Med . 1983;;308:788-792.
16 +
Iglehart JK.  Medicare begins prospective payment of hospitals. N Engl J Med . 1983;;308:1428-1432.
17 +
Hornbrook MC, Scheffler RM, Rossiter LF, eds. Risk-Based Contributions to Private Health Insurance: Advances in Health Economics and Health Services Research, XII . Greenwich, Conn: Jai Press; 1991;.
18 +
Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach . Norwalk, Conn: Appleton and Lange; 1995;.
19 +
Casalino LP.  Balancing incentives: how should physicians be reimbursed? JAMA . 1992;;267:403-405.

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