Health Affairs

Health Affairs, 26, no. 6 (2007): 1586-1598 doi: 10.1377/hlthaff.26.6.1586 © 2007 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

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Physician Services

Unhealthy Trends: The Future Of Physician Services

Hoangmai H. Pham and Paul B. Ginsburg

In this paper we review current trends in payment systems, work settings, favored services, and accountability mechanisms that characterize physician practice. Current trends are pointing to higher spending, more tiering of access to care by ability to pay, and a greater role for larger practices that include both primary care and specialist physicians. Medicare’s purchasing role is policymakers’ most powerful lever to alter negative trends. Making fee-for-service payment more accurately reflect cost structures could immediately address some of these issues. Medicare can lead longer-term efforts to incorporate more per episode and capitated elements into the payment system, revamping incentives for physicians.

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