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The Costs of Making Practice More Cost-effective
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To the Editor: Dr Mason and colleagues1 derived an economic model, based on England's National Healthcare System (NHS), for determining when it might be cost-effective to try to change physician behavior. Although health care is not nationalized in the United States, some health care services for eligible elderly and disabled patients are federally funded through Medicare. Three differences between the NHS and Medicare must be recognized before the model of Mason et al1 can be applied to Medicare policy.
First, under Medicare, physicians incur costs when changing their practices. In the NHS, it may be reasonable to assume no costs associated with practice change; physicians are salaried and apparently have an allocation of time dedicated to such pursuits. For US physicians who are obtaining Medicare reimbursement for services, time spent away from patient care represents lost income. Although the low Medicare reimbursement rates may mitigate the effect somewhat, this financial . . . [Full Text of this Article]
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