Kirkman-Liff B L
Arizona State University.
J Health Polit Policy Law. 1990 Spring;15(1):69-99. doi: 10.1215/03616878-15-1-69.
The West German health care system pays ambulatory care physicians on a fee-for-service basis but employs a national relative value scale and regional capitation-based revenue pools to achieve expenditure controls on total physician reimbursement. Physician-controlled organizations manage these pools and conduct utilization reviews on their own members. The capitation rates are determined by negotiations between the physician associations and health insurers. The West German government has been able to exert some influence on the outcome of these negotiations through a quasi-governmental advisory body. Aspects of this structure could be adopted by Medicare in order to determine conversion factors for resource-based relative value scales or to create expenditure control and incentive structures for Medicare-participating physicians.
西德医疗保健系统按服务收费的方式向门诊医生支付费用，但采用全国相对价值尺度和基于区域人头费的收入池来控制医生报销的总支出。由医生控制的组织管理这些收入池，并对其成员进行使用情况审查。人头费率由医生协会和健康保险公司之间的谈判确定。西德政府能够通过一个准政府咨询机构对这些谈判的结果施加一定影响。医疗保险制度可以采用这种结构的一些方面，以便确定基于资源的相对价值尺度的转换因子，或为参与医疗保险的医生建立支出控制和激励结构。
