See how other high-income countries regulate costs

Standardizing fee-for-service payments and structuring negotiations between insurers and providers could make healthcare in the United States more affordable, according to the Rutgers study.

Structuring negotiations between insurers and providers, standardizing fee-for-service payments, and negotiating prices can reduce healthcare spending in the United States by slowing the rate at which healthcare prices, according to a Rutgers study. health increases.

The study, published in the journal Health affairs, examined how other high-income countries that use a fee-for-service model regulate health care costs.

Although the United States has the highest healthcare prices in the world, the specific mechanisms commonly used by other countries to set and update prices are often overlooked. In most countries with universal health insurance, doctors are paid on a fee-for-service basis, but health care prices are lower than in the United States.

To cut health care spending, US policymakers have focused on eliminating fee-for-service reimbursement, which encourages providing additional services rather than engaging in price negotiations to tackle the main driver which stimulates health care spending.

US policymakers stress the need to reduce the volume of care provided by the system, but previous research shows healthcare spending in the US is higher than in other countries because of price, not volume , services.

The researchers compared policies in France, Germany and Japan, where payers and physicians engage in structured negotiations of fees and standardized prices in systems where fee-for-service is the primary model of reimbursement of outpatients. They interviewed 37 health policy stakeholders and experts in these three countries to understand the process of creating physician fee schedules and updates, to learn about recent changes in physician compensation policy. and to identify remaining challenges in the use of fee-for-service physicians.

“The parties involved, the frequency of fee schedule updates and the scope of negotiations vary, but the three countries are trying to balance the interests of payers with those of physician associations,” said lead author Michael K. Gusmano, lead author of the study and a professor at the Rutgers School of Public Health and researcher at the Hastings Center.

The expansion of public insurance and the creation of universal health care coverage for residents of the United States were popular – even more during the COVID-19[feminine pandémie. Cependant, il est essentiel de s’attaquer au prix des soins de santé pour rendre la couverture universelle abordable.

L’utilisation du paiement à l’acte pour les médecins pose des problèmes, mais le fait de marquer la rémunération à l’acte comme la principale cause des dépenses de santé élevées aux États-Unis est problématique, d’autant plus que les pays où les prix et les dépenses sont plus bas utilisent la rémunération systèmes de services, tout en fournissant des soins de santé universels à ses résidents. La France, l’Allemagne et le Japon limitent les revenus des médecins en normalisant et en ajustant les honoraires qui leur sont payés tout en utilisant diverses approches pour limiter le volume des services fournis.

Selon Gusmano – qui est également membre du Rutgers Institute for Health, Health Care Policy and Aging Research et du Rutgers Global Health Institute – que les États-Unis poursuivent ou non des changements politiques fondamentaux tels que Medicare for All ou l’expansion progressive de Care Act, les deux exigeraient que les décideurs politiques abordent les prix des soins de santé.

Référence: «Obtenir le bon prix: comment certains pays contrôlent les dépenses dans un système de rémunération à l’acte» par Michael K. Gusmano, Miriam Laugesen, Victor G. Rodwin et Lawrence D. Brown, 2 novembre 2020, Affaires sanitaires.
DOI: 10.1377 / hlthaff.2019.01804