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Doctors and public authorities: the trend toward collaboration
1New School for Social Research, New York City.
Insights
Successful healthcare financing systems require collaboration between medical professionals and payers. Many countries have adopted joint decision-making, but the U.S. needs to resolve conflicts by creating similar systems.
Area of Science:
- Health Services Research
- Health Economics
- Medical Sociology
Background:
- Comprehensive healthcare financing systems are essential for population coverage and financial management.
- The expansion of third-party reimbursement has historically created conflicts between medical professionals and payers regarding practice, work rules, and compensation.
- Resolving these conflicts is crucial for the harmonious operation of healthcare services.
Purpose of the Study:
- To analyze the evolution of healthcare financing systems and the role of the medical profession within them.
- To identify successful models for collaboration between healthcare providers and financing organizations (insurers and government).
- To assess the impact of different healthcare financing structures on the relationship between policymakers, financial managers, and the medical profession.
Main Methods:
- Longitudinal, first-hand field research spanning over thirty years.
- Qualitative data collection including informant interviews and analysis of reports.
- Observational studies of healthcare systems in developed countries in Europe and North America.
Main Results:
- Many developed countries have established new systems for negotiation and joint decision-making between governments/payers and medical professionals.
- These collaborative models aim to motivate the medical profession and ensure system success.
- The United States remains an exception, characterized by ongoing conflicts due to a lack of a joint decision-making framework.
Conclusions:
- Collaborative, peer-based decision-making between medical professionals and financing bodies is key to successful healthcare systems.
- The U.S. healthcare system requires a shift towards joint decision-making to mitigate persistent conflicts.
- International comparisons highlight the benefits of integrated approaches in healthcare financing and delivery.
Abstract:
Insuring a population and managing its money require a comprehensive health care financing system. Many issues must be resolved, particularly the roles of the medical profession and its relationship with organizations of laymen in insurance carriers and in government. The spread of society-wide, third-party reimbursement produced conflicts with doctors over admission to practice, work rules, and pay in all countries. Eventually new arrangements were made to settle conflicts of interest and to ensure the harmonious operation of health care services. Policymakers and financial managers came to realize that the medical profession as a whole must be motivated to ensure the success of the system. Recently countries with statutory health insurance and direct public financing created new systems for negotiation and for joint decision making. Even some governments now agree to collaborate with doctors as virtual peers rather than to dictate rules and finance. The only exception is the United States, which will continue to have periodic conflicts until it crafts a joint decision-making system. The evidence comes from the author's first-hand field research over thirty years in the principal developed countries in Europe and North America. He interviewed informants, collected reports, and observed events for these topics primarily in Germany, France, the Netherlands, Great Britain, Canada, and the United States.