Gusmano Michael K, Laugesen Miriam, Rodwin Victor G, Brown Lawrence D
Michael K. Gusmano (
Miriam Laugesen is an associate professor in the Department of Health Policy and Management in the Mailman School of Public Health, Columbia University, in New York, New York.
Health Aff (Millwood). 2020 Nov;39(11):1867-1874. doi: 10.1377/hlthaff.2019.01804.
Although the US has the highest health care prices in the world, the specific mechanisms commonly used by other countries to set and update prices are often overlooked, with a tendency to favor strategies such as reducing the use of fee-for-service reimbursement. Comparing policies in three high-income countries (France, Germany, and Japan), we describe how payers and physicians engage in structured fee negotiations and standardize prices in systems where fee-for-service is the main model of outpatient physician reimbursement. The parties involved, the frequency of fee schedule updates, and the scope of the negotiations vary, but all three countries attempt to balance the interests of payers with those of physician associations. Instead of looking for policy importation, this analysis demonstrates the benefits of structuring negotiations and standardizing fee-for-service payments independent of any specific reform proposal, such as single-payer reform and public insurance buy-ins.
尽管美国的医疗保健价格是全球最高的，但其他国家通常用于设定和更新价格的具体机制却常常被忽视，人们倾向于采用诸如减少按服务收费报销方式的使用等策略。通过比较三个高收入国家（法国、德国和日本）的政策，我们描述了在按服务收费是门诊医生报销主要模式的体系中，支付方和医生如何进行结构化的费用谈判并使价格标准化。参与各方、费用表更新的频率以及谈判的范围各不相同，但所有这三个国家都试图平衡支付方与医生协会的利益。该分析并未寻求政策移植，而是展示了独立于任何具体改革提议（如单一支付方改革和公共保险纳入）来构建谈判并使按服务收费支付标准化的益处。
