Keeping German Doctors On A Budget Lowers Costs : NPR:
"How Doctors Get Paid
Nearly all hospital-based doctors are salaried, and those salaries are part of hospital budgets that are negotiated each year between hospitals and 'sickness funds' — the 240 nonprofit insurance companies that cover nearly nine out of 10 Germans through their jobs. (About 10 percent, who are generally higher income, opt out of the main system to buy insurance from for-profit companies. A small fraction get tax-subsidized care.)
Office-based doctors in Germany operate much like U.S. physicians do. They're private entrepreneurs who get a fee from insurers for every visit and every procedure they perform. The big difference is that groups of office-based physicians in every region negotiate with insurers to arrive at collective annual budgets.
Those doctor budgets get divided into quarterly amounts — a limited pot of money for each region. Once doctors collectively use up that money, that's it — there's no more until the next quarter.
It's a powerful incentive for doctors to exercise restraint — not to provide more care than is necessary. But often, the pot of money is exhausted before the end of the quarter."
Interesting piece from over the Fourth holiday. It was mostly about the last paragraph above: Namely that physicians have to decide whether to continue to provide service until the end of the quarter when the budget is already exhausted. Seems bizarre to physicians here, except that we do the same thing, only play the game differently.
The way we do it is not quarterly, but on an ongoing basis. Most of our patients have insurance that pays us (more or less) what we expect, but a certain percentage have Medicaid or are uninsured altogether or have crappy insurance that doesn't cover whatever you just took care of, and so on. So the net effect is similar.
But another intersting tidbits is the salaried nature of hospital based physicians. It would be interesting to see what the contracts look like in terms of benefits, vacation, salary, etc.
Wednesday, July 23, 2008
Keeping German Doctors On A Budget Lowers Costs : NPR
Subscribe to:
Post Comments (Atom)
2 comments:
I find it very interesting that Germany was cited as the example of a well functioning healthcare delivery system. I am an American Healthcare provider and recently returned from living in Germany for eight years. My wife is German and had initially refused to use anyone but German providers indicating, “All American doctors want to do is make money.” Having removed that stigma from her mind she opened up to, the idea of seeing an American “doctor” and I agreed to see a German Hospital to see just how different it could be.
I first educated myself to some of the inherent differences in the systems (essentially what the article has outlined) but I was amazed at what those differences could translate into. While there was, a slight reduction in availability of services and a notional “wait” time before referrals were complete or specialists were available the system was-in my humble opinion- fast, efficient, and comprehensive. I had no complaints.
My wife’s experience was somewhat different. We waited 45 days for a physical appointment that ended up being cancelled and rescheduled a further five days later. The 15-minute appointment ended up being more like a rushed 10 minutes in a very loud crowded office. My wife’s biggest complaint was not with the provider but was with the system. I could not have agreed with her more. I believe she correctly identified that at its root cause, the American healthcare System, attempts to do a good job but is so constrained by rules and regulations, costs, and litigation fears it cannot.
Universal Health Insurance does not sound appealing to many (I would imagine that the 44 million uninsured could argue that) but can’t we all agree that something g in the American system has to change? How can American big business, small companies and the self-employed provide coverage if it is too expensive? Cost cutting and denial of service is not the answer. A comprehensive coverage plan that covers all citizens could be the answer or at least a good place to start.
Major Jay Schuster, US Army, Command and General Staff College (student), Fort Leavenworth Kansas
The opinions expressed within this article are those of the author and not the United States Army, Department of Defense, or the Government of the United States
Thanks, Major, for your comment.
"I believe she correctly identified that at its root cause, the American healthcare System, attempts to do a good job but is so constrained by rules and regulations, costs, and litigation fears it cannot. "
This is so true and so frustrating for those of us in medicine. I always find it laughable when those outside the sytem say things like, "You'll lose your choice/autonomy under universal healthcare," or, "Do you want government bureaucrats making healthcare decisions?"
They don't realize how bad it has gotten under private profiteers/insurers. And I am largely exempt, as an intensive care physician, from a lot of the pure crap that my colleagues in primary care have to put up with!
Click on the topic "single payer: physicians opinions" for more info on this topic. This blog is here as a resource. I hope you'll direct people towards it if they just want to get better informed.
Cheers,
Chris
Post a Comment