The Politics of Paying Physicians: The Determinants of Government Payment Methods in England,Sweden,and the United States

Abstract

This paper most generally seeks to account for why governments pay doctors as they do. It evaluates the hypothesis that, among western industrial countries, widely known physician preferences on method of pay determine subsequent policy, whatever the bargaining arrangements and distinctive national political setting. Two bodies of data are used: primary studies of payment method decisions in Sweden, England, and the United States, and secondary information on methods of payment employed throughout the world complied by Glaser. The data proved consistent with the factual hypothesis. The explanation offered stresses the structural imbalance between the political resources (and willingness to use them) of physicians and governments on questions of payment method. This account has policy implications quite different from those stressing the impact of bargaining forms and settings in payment method decisions.

Get full access to this article

View all access options for this article.

References

Abel-Smith

Health expenditure in seven countries. The Times Review of Industry and Technology, p. VI, March 1963.

Department of Health, Education, and Welfare. A Report to the President on Medical Care Prices. Government Printing Office, February 1967.

Horowitz

L. H.

Medical care price changes during the first year of Medicare. Research and Statistics Note No. 18, pp. 3–4. Social Security Administration, October 31, 1967.

Chase

E. T.

The doctors' bonanza. The New Republic, No. XV: 15–16, April 1967.

Marmor

T. R.

Why Medicare helped raise doctors' fees. Trans-action, September 1968.

British Medical Association. A Charter for the Family Doctor Service, p. 1. March 9, 1965.

Confidential interviews with British Medical Association officers and Ministry of Health officials, Spring 1967.

Eckstein

Pressure Group Politics. The Case of the British Medical Association. G. Allen and Unwin, Ltd., London, 1960.

Abel-Smith

Paying the family doctor. Med. Care 1(1): 27–35, 1963.

10.

Abel-Smith

The major pattern of financing and organisation of medical services that have emerged in other countries. Med. Care 3(1): 33–40, 1965.

11.

Glaser

W. A.

Paying the Doctor: Systems of Rumuneration and Their Effects. Johns Hopkins Press, Baltimore, 1970.

12.

Schnur

J. A.

Hollenberg

R. D.

The Saskatchewan medical care crisis in retrospect. Med. Care 4(2): 111–119, 1966.

13.

Badgley

R. F.

Wolfe

Doctors' Strike: Medical Care and Conflict in Saskatchewan. Macmillan Company of Canada Limited, Toronto, 1967.