So, it seems as though FFS still dominates in the US, and some (including me) might see FFS as particularly inflationary. But other systems also heavily use FFS and, though health care expenditure growth may be problematic, it has not been as problematic as it has been in the US.
The key might therefore be the keep the FFS system within a reasonable overall budget constraint. It seems to me that a special feature of the US is that the payers (employers, government) are more willing to pay the increasing fees charged by providers without too much questioning, so to control total US health care expenditure growth, there needs to be reform not necessarily of the way physicians are paid, but of the control that the payers exert over total budget. I guess this was tried with managed care, and then the backlash (which was really a backlash against HMOs rather than managed care wasn't it? - the number of PPOs exploded between the-mid 1990s and now - but let's not wind Ted up any further about definitions of managed care).
Another reason why this type of reform (i.e. strenghening the role of the payer) may be particularly difficult in the US is that there are so many different sectors within the one country (this point came to me from speaking to Larry Brown and Howard Berliner, so if my ideas here are useless, we can blame them...). So if you take the Oregon experiment, a main reason why it seemed to fail is because Medicaid patients and their advocates thought that it was unfair that their care was being further constrained whilst that of those covered in the private sector wasn't. In many other countries, these cross sector comparisons within a country may not be quite so much of a problem (this might feed into Michael and Anna's debate about whether different baskets of services across states would be a problem in a Medicaid for all programme).
Anyway, I should do some work, and should refrain from writing what everyone already knows. But greater payer control seems to be the key (?), but that might call for a more unified system than previous reforms and plans to build upon the existing system (Medicare/Medicaid, and last year's Obama proposals). But that may be politically impossible. So perhaps we should study education instead.
Best,
Adam
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