Learning from the Legal History of Billing for Medical Fees

Hall, Mark A.; Schneider, Carl E.

doi:10.1007/s11606-008-0605-1

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…At this particular time, basic healthcare as administered by general or family practice physicians was fee-for-service and out-of-pocket for consumers on a sliding scale based on the consumer's ability to pay. (Hall & Schneider, 2008) Hall and Schneider state, "Sliding scales flourished not because of ethical edicts but because they were an economic advantage or even necessity. When the cross-subsidies of insurance premiums replaced the cross-subsidies of the sliding fee scale, the tentative professional ethic of that scale yielded to the market ethic of standard fees.…”

Section: A Brief History Of Healthcare Policies In the United Statesmentioning

confidence: 99%

“…(2008) The sliding scale method of determining the price of an office visit to the family physician did not survive the 1965 Medicare & Medicaid legislation. (Hall & Schneider, 2008) In 1965, congress took the second major step towards single-payer medical insurance system with the passage of two landmark entitlement programs: Medicare for the elderly, and Medicaid for the indigent and their dependents. This combination of Medicare, Medicaid, private insurance, and other minor federal programs, resulted in a third-party payment system in which the price of health care was obscured from patients because someone else was paying their medical bills.…”

Section: A Brief History Of Healthcare Policies In the United Statesmentioning

confidence: 99%

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Physician-to-patient Direct Primary Care: Entrepreneurial Country Doctors Offer a NewMedical Business Model

McCutcheon¹,

McCoy²

2019

aeb

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Starting in 1942, the United States federal government introduced five major healthcare policies with the intention of reducing the cost of healthcare while insuring millions of people without health insurance. These actions have steered the country towards a monopolistically competitive posture in the medical industry, and compelled consumers to purchase services from few companies at progressively higher prices. The laws of supply and demand cannot be changed, altered, or forced into contortions outside of their nature. Rather than work against market forces, the answer to monopolistic competition is to decentralize the market. Increasing competition for the consumer-patient using common sense, transparent pricing and visible menu lists in physicians' offices will lead to lower market prices for goods and services.

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Section: A Brief History Of Healthcare Policies In the United Statesmentioning

confidence: 99%

Section: A Brief History Of Healthcare Policies In the United Statesmentioning

confidence: 99%

Physician-to-patient Direct Primary Care: Entrepreneurial Country Doctors Offer a NewMedical Business Model

McCutcheon¹,

McCoy²

2019

aeb

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“…The use of sliding fee scales persisted until widespread health insurance drove a standardisation of fees (Hall and Schneider, 2008). Nonetheless, supplementary fee systems continue to exist in countries with universal health insurance.…”

Section: Introductionmentioning

confidence: 99%

“…Driven by the economics of medical practice prior to the spread of health insurance, physicians applied price discrimination by charging patients according to what they thought each patient could afford. The use of sliding fee scales persisted until widespread health insurance drove a standardisation of fees (Hall and Schneider, 2008). Nonetheless, supplementary fee systems continue to exist in countries with universal health insurance.…”

Section: Introductionmentioning

confidence: 99%

Supplementary physicians’ fees: a sustainable system?

Calcoen

Ven

2018

HEPL

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In Belgium and France, physicians can charge a supplementary fee on top of the tariff set by the mandatory basic health insurance scheme. In both countries, the supplementary fee system is under pressure because of financial sustainability concerns and a lack of added value for the patient. Expenditure on supplementary fees is increasing much faster than total health expenditure. So far, measures taken to curb this trend have not been successful. For certain categories of physicians, supplementary fees represent one-third of total income. For patients, however, the added value of supplementary fees is not that clear. Supplementary fees can buy comfort and access to physicians who refuse to treat patients who are not willing to pay supplementary fees. Perceived quality of care plays an important role in patients' willingness to pay supplementary fees. Today, there is no evidence that physicians who charge supplementary fees provide better quality of care than physicians who do not. However, linking supplementary fees to objectively proven quality of care and limiting access to top quality care to patients able and willing to pay supplementary fees might not be socially acceptable in many countries. Our conclusion is that supplementary physicians' fees are not sustainable.

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“…3 One critical function of safetynet programs, therefore, could be to negotiate lower-end market rates for people who can't afford insurance and to provide deeper discounts as medical costs mount over the course of a patient's treatment. Perverse market conditions allow U.S. hospitals to charge uninsured pa-tients two to four times as much as insured patients for the same services, and physicians often charge them 50 to 250% more.…”

mentioning

confidence: 99%