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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: TimF who wrote (13805)	3/3/2010 2:21:28 PM
From: Road Walker	1 Recommendation Read Replies (1) \| Respond to of 42652

I get the service, I pay a free, that's "fee for service". Getting rid of fee for service would put pressure on the provider, not the insurance company. If the provider were paid a flat fee for an entire procedure made up of a bunch of services, it would be in his best interest to limit the number of services (to save money). In fee for service, it's in his best interest to order as many profitable services as possible.

To: TimF who wrote (13805)	3/3/2010 3:48:26 PM
From: Lane3	Respond to of 42652

Fee for service doesn't imply or require having an insurance company (or any type of insurance such as government insurance, insurance from your association, or even a self insurance fund). I don't see how you can have a fee-for-service policy without an insurance company. I get the service, I pay a free, that's "fee for service". OK, I see the disconnect now, at least I think I do. I don't know that the term "fee-for-service" is used outside the construct of an insurance policy. I googled "fee for service definiton" and they were all in the context of insurance policies. I think what you have in mind is called "self insuring." Even had I not specified "fee-for-service policy," I think "policy" would be assumed. But maybe not. Anyway, now that we know what we're talking about... <g> If you have third party paying, I'm not sure that fee for service does much good or harm in containing costs. The only way a fee-for-service plan can cut costs it to take some benefits off the table entirely or to negotiate (or bully) lower payments. Fee-for-service plans are volume driven and there's nothing to stop the volume of allowable benefits as providers and patients seek more of them. Alternatives to fee-for-service are typically some combination of provider/insurer like Kaiser. They can control volume by setting protocols that restrict the doctor's freedom to order procedures and putting providers on salary, capitation, global payments and the like. That takes care of the volume problem. It may cause other problems but it does limit volume.