Physician, cut thy costs - medical providers are considering taking part in the cost cutting battle - includes related information on physician specialization, American College of Physician's reform criteria, and worker's compensation - Cover Story

Business & Health, June, 1991 by M. Mary Conroy

* There should be mechanisms for controlling costs. There should be incentives for patients to obtain, and for health care providers to deliver, health care services in a cost effective manner. Charges and payments for health care services should be based on objective determinations of reasonableness.

* Administrative expenses and procedures should be minimized. Requirements for billing, completion, and processing of forms, and other paperwork should not deter health care professionals from working within the system. Providers of health care should not have to be subjected to complicated and differing rules and requirements from a multitude of insurers and other third-party payers.

* Professional liability costs should be minimized. The direct costs of medical malpractice insurance, as well as the indirect costs of added tests and procedures done to reduce the risk for malpractice litigation, add significantly to overall health care costs. Restructuring of the professional liability system, including necessary elements of tort reform, should be an integral part of health care reform.

* Existing sources of revenue should be incorporated into any new financing system. It is critical that resources now available to the system not be lost, although they may assume a different form. For example, resources from employers presently providing coverage [as well as] governmental programs...should be incorporated.

Organization and delivery

* There should be a sufficient infrastructure in terms of both facilities and manpower to deliver health care services efficiently and effectively. Health planning will be needed to ensure that resources are best allocated to meet needs and to avoid unnecessary duplication, waste, and inefficiency.

* There should be mechanisms to assure quality. Patients must be able to express their satisfaction or dissatisfaction with the quality of services they receive by being able to choose among providers.

* Innovation and improvement should be fostered. Sufficient resources must be devoted to research and development to achieve continued advances in medical science.

* The system should be flexible. The system should permit various organizational models for delivery of health care services, including private practice, group practice arrangements, health maintenance organizations, and preferred provider organizations.

* Incentives should be provided to encourage individuals to take responsibility for their own health, seek preventive health care, and pursue health promotion activities. The system should also encourage Americans to cease engaging in unhealthful activities such as smoking, alcohol abuse, and drug use.

Satisfaction

* Patients should be satisfied. Patients should have the ability to choose their own physicians and the type of setting from which they obtain health care services. Patients should also be able to understand easily how to obtain and pay for care.

* Physicians and other health care professionals should be satisfied. Appropriate professional judgment should not be impeded. Inappropriate infringements on this activity may discourage the most promising candidates from seeking or remaining in medical careers.