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Fee controls as cost control: tales from the frozen North
M L Barer1, R G Evans, R J Labelle
1University of British Columbia.
The Milbank Quarterly
|January 1, 1988
Summary
Uniform physician fee schedules aim to control costs and improve patient access. However, evidence from Canadian provinces suggests a multipronged approach involving fees, practice patterns, and physician numbers is essential for success.
Area of Science:
- Health economics
- Public policy
- Physician payment models
Background:
- Uniform and binding physician fee schedules are proposed as cost-control measures.
- These policies aim to enhance patient access and equitably distribute healthcare costs.
- Opposing views predict adverse effects on service utilization and overall costs.
Purpose of the Study:
- To examine the empirical evidence on the effects of uniform physician fee schedules.
- To challenge existing economic theories of physician behavior using real-world data.
- To analyze the impact of innovative fee policies in Canadian provinces.
Main Methods:
- Analysis of innovative policies implemented in two Canadian provinces.
- Examination of a national framework guiding provincial policies.
- Focus on a multipronged approach encompassing fees, practice patterns, and physician workforce.
Main Results:
- Canadian provincial experiences highlight the complexity of implementing fee schedules.
- A combination of policy levers is more effective than fee schedules alone.
- Political will and continuous negotiation are critical for policy success.
Conclusions:
- Uniform fee schedules alone may not achieve desired cost-control or access improvements.
- A comprehensive strategy addressing physician payment, practice behavior, and supply is necessary.
- Successful implementation requires sustained political commitment and adaptive negotiation.