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PREFACE
The methods of physician payment and their effects on the costs and
characteristics of medical care have recently moved up on the national
health policy agenda. For many years the focus of policy attention and
experimentation was on hospital payment. Physician payment issues were
relatively little examined, even though health care analysts frequently
acknowledged the primacy of physician decision-making in the allocation
of health care resources. Now with the dramatic change in Medicare
reimbursement to hospitals, along with continuing fear about the
financial viability of the Medicare program, private sector actions to
moderate health cost increases, and the rapid expansion of the physician
supply, the Congress and other policymakers are indicating it may be time
to reconsider the methods of physician payment e
The Institute of Medicine's interest in the issues of physician
payment arose primarily from its members, concerns about the effects of
physician payment methods on the nature of health care, rather than the
cost issue itself. The conference summarized here and the accompanying
background papers arose from these members' concerns. Although the
conference was convened primarily to provide advice to the IOM on how it
might best approach these issues, many inquiries about the conference
have led us to make this summary and the background papers available for
the information of those with interest in methods of physician payment.
The surge of interest by Congress has resulted in current studies of
physician payment methods by the Health Care Financing Administration and
the Office of Technology Assessment. A major study on this topic is
being proposed by the IOM, and other groups have indicated their intent
to conduct studies. If the forces for change are gathering momentum, a
better understanding of the issues and the range of relevant perspectives
should be useful to all concerned with physician payment methods. The
conference participants represented many different viewpoints, and the
background papers and authors represented the judgment of the planning
committee about aspects of the topic that deserved attention by the
participants. The papers were intended to stimulate thought and to
provide a more common basis of understanding f or a diverse group. We
hope these proceedings can serve those purposes for others as well.
We wish to thank the planning group and the discussion group leaders
for their efforts to steer the IOM through the turbulent waters of a
controversial topic while making headway toward a productive IOM role in
further study. Special thanks go to Paul Bee son for his even-handed and
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stimulating chairing of the conference and for his counsel concerning
follow-up steps. The background paper authors and the initial speakers
admirably fulf illed their assigned roles of provocation and insight.
Finally, Sunny Yoder of the IOM staff has my personal appreciation not
only for this summary, but, also, for her important work in planning the
conference and developing the subsequent IOM study proposal.
Because the purpose of the conference was to stimulate thoughts and
suggestions for the IOM, we hope that readers of these proceedings who
were not present will feel free to give us the benefit of their ideas and
reactions as the IOM continues its engagement with these important issues.
Karl D . Yo rdy
Senior Program Officer and
Director, Division of Health
Care Services
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