Implications of physician reimbursement reform: patient access and physicians' practice

Physicians have been and will continue to be key agents in the health care delivery system. Their relative role and methods of practice, however, are undergoing significant change. This change has been induced by increased competitiveness, continued efforts at cost containment, and changes in reimbursement methods. While the most dramatic change in reimbursement (diagnosis-related groups, DRGs) was directed at the hospital, the reform of physician reimbursement is currently a high priority of the federal government. Changes in federal payments to physicians have significant implications for physicians and their patients. Several recent developments, indeed, may become the trends of the latter part of the 1980s. These developments include changes in physicians' practice mode, lower returns to medical education, increased diversification of physicians' activities, changes in relative earnings of physicians by specialty and age, restricted physician choice for some patients, and increased problems with overall access.