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This article describes the design and methods of a study currently under way to develop a Resource-Based Relative Value Scale (RBRVS); an alternative basis for establishing the payment rate for the services and procedures (S/Ps) of physicians in medical and surgical specialties. Physician resource inputs to be measured include (1) S/P time, (2) pre-S/P and post-S/P times, (3) intensity, (4) practice costs, including malpractice premiums, and (5) the cost of specialty training. These five factors will be combined to produce an RBRVS denominated in nonmonetary units. In the initial phase of the study, data on time and intensity will be obtained through a national survey of physicians who perform these S/Ps. In the second, consensus phase of the project, the investigators will convene a panel of representatives of the medical profession, third-party payers, consumers, and other interested parties to examine areas of agreement and disagreement as to how an RBRVS should be used for policy purposes. The final results of this study are expected by the summer of 1988.
This article describes the design and methods of a study currently under way to develop a Resource-Based Relative Value Scale (RBRVS); an alternative basis for establishing the payment rate for the services and procedures (S/Ps) of physicians in medical and surgical specialties. Physician resource inputs to be measured include (1) S/P time, (2) pre-S/P and post-S/P times, (3) intensity, (4) practice costs, including malpractice premiums, and (5) the cost of specialty training. These five factors will be combined to produce an RBRVS denominated in nonmonetary units. In the initial phase of the study, data on time and intensity will be obtained through a national survey of physicians who perform these S/Ps. In the second, consensus phase of the project, the investigators will convene a panel of representatives of the medical profession, third-party payers, consumers, and other interested parties to examine areas of agreement and disagreement as to how an RBRVS should be used for policy purposes. The final results of this study are expected by the summer of 1988.
Medical associations not only organize their members’ interests, but also exercise professional authority within the field of health policy. An important aspect of professional authority is the medical profession’s ability to position itself in relation to national health policy and whether its command of professional knowledge enables the profession to claim exclusive authority to reflect on health policy. This article analyzes and compares how medical associations claim authority over health policy and how they reposition their claims in light of perceived contestations to medical authority in public debates or from the political system. The study is based on a qualitative, descriptive analysis of 975 editorials in the medical associations’ lead journals in the United States, the United Kingdom, and Denmark over sixty years. The analysis explores the trajectories of authority claims in the three countries and how professional authority claims may be reconfigured to reflect external changes in health policy institutions. Whereas all the medical associations were highly critical of state-organized health systems in the 1950s and early 1960s, the British and Danish associations seem to shift positions entirely after the national health systems are gradually implemented and the associations begin to present themselves as these public institutions’ strongest supporters.
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