Is medicine`s version of ”pay-as-you-go”–the traditional method of paying doctors on a fee-for-service basis–the way to go?
The April 24, 1986, issue of the New England Journal of Medicine contains a study from Harvard certain to cause explosive discussion among health care experts–and practicing physicians. Specifically, this study attempts to address the important issue of whether or not fee-for-service doctors were more likely to order tests than were doctors practicing in prepaid plans.
To answer this question, the Harvard researchers compared the rate at which 10 doctors practicing in large fee-for-service groups ordered tests on individuals with uncomplicated high blood pressure–and compared that rate with that of 17 doctors in a large prepaid group practice.
In brief, the article found ”50 percent more electrocardiograms were obtained among patients in fee-for-service practices . . . and 40 percent more chest radiographs . . . ” The authors concede that their conclusions, ”based on this limited study, must be considered tentative, (but) the findings suggest that it may be appropriate to consider changing the payment for tests as part of a more general reform of the fee schedules.”
Obviously, one could argue that the prepaid plans were actually
”skimping” on appropriate medical care, with an incentive to cut back on test costs as the reason. The other side of the argument is that the fee-for- service physicians were ordering unnecessary tests in an attempt to increase their income. Which of these explanations is true is an important question in terms of both health care cost and quality.
