REFORMING PHYSICIAN PAYMENT -- Copyright -- Contents -- PREFACE -- CONFERENCE SUMMARY -- Conference Agenda -- Major Conference Themes -- A Climate for Change -- A Need for Change -- Non-economic Influences on Physician Behavior -- Payment Objectives -- Paucity of Data and Research Findings -- Potential Contributions by the Institute of Medicine -- COMMISSIONED PAPERS -- POLITICS AS USUAL AND CUSTOMARY? PHYSICIAN PAYMENT IN TRANSITION -- THE PERPLEXING TARGET OF POLICY -- THE RISE AND DECLINE OF USUAL AND CUSTOMARY -- FORCES FOR CHANGE -- PROSPECTS FOR CHANGE -- CHALLENGES OF CHANGE -- References -- CHANGING PHYSICIAN BEHAVIOR: In Search of the Little Blue Button -- SUMMARY -- INTRODUCTION -- PRIMARY INFLUENCES -- ENVIRONMENTAL CHANGES -- NEW RESEARCH INITIATIVES -- References -- THE IMPACT OF CHANGES IN PAYMENT METHODS ON THE SUPPLY OF PHYSICIANS' SERVICES -- INTRODUCTION -- THE PAYMENT SYSTEM AND PHYSICIANS' SPECIALTY AND LOCATION DECISIONS -- Location Choices -- Specialty Choice -- PHYSICIANS' PRODUCTIVITY -- Defining Efficiency and Productivity -- Productivity in Solo, Fee-for-Service Practice -- Productivity in Group, Fee-for-Service Practices -- Productivity in Pre-Paid Group Practice -- PARTICIPATION IN HEALTH INSURANCE PROGRAMS -- CONCLUSIONS -- References -- THIRD PARTY CARRIER PERSPECTIVE ON PHYSICIAN PAYMENT -- PAYMENT IS A MEANS, NOT AN END -- The Patient -- The Physician -- The Payor -- The Public -- The Carrier -- THERE ARE FUNDAMENTAL DIFFERENCES BETWEEN INSTITUTION-CARRIERS AND PROFESSIONAL-CARRIER RELATIONSHIPS -- Specialization -- Location -- Target Income -- Controls -- Competition -- Dissatisfaction -- A PAYMENT SYSTEM SHOULD BE IN REASONABLE SYNCHRONIZATION WITH THE EVOLUTION OF THE SOCIAL AND DELIVERY SYSTEMS -- PAYMENT SYSTEMS ARE DESIGNED FOR SPECIFIC BENEFIT, ADMINISTRATIVE, AND LEGAL CIRCUMSTANCES.

FEE-FOR-SERVICE PAYMENTS ARE GOVERNED PRIMARILY BY THE MARKET -- ALL PAYMENT SYSTEMS CARRY INCENTIVES FOR SPECIFIC TYPES OF BEHAVIOR -- The Payment System -- The Utilization Control System -- Benefit Design -- Medical Policy -- Physician Education -- Claims Analysis and Intervention -- PAYMENT SYSTEMS ARE CONSTRAINED BY THE OBJECTIVES OF THE BUYER AND BY HIS PHILOSOPHY AND THE DEGREE OF COMMITTMENT TO THOSE… -- ANTITRUST AND PHYSICIAN PAYMENT -- THE ORIGINS AND ELEMENTS OF ANTITRUST ANALYSIS -- Historical Underpinnings -- The Antitrust Statutes -- Elements of Analysis -- Application of the Antitrust Laws to the Professions -- EFFECT OF ANTITRUST ON PROFESSIONAL PRACTICE -- THE EFFECT OF THE ANTITRUST LAWS ON INSURERS -- NEW METHODS FOR PAYING PHYSICIANS -- SUMMARY AND CONCLUSIONS -- FOOTNOTES -- PHYSICIAN PAYMENT METHODS: FORMS AND LEVELS OF PHYSICIAN COMPENSATION -- Summary of Findings -- Distribution of U.S. Physicians Among Employment/Activity Groups -- References -- APPENDICES -- Appendix A -- PARTICIPANTS -- Institute of Medicine Staff -- Appendix B -- CONFERENCE PROGRAM -- Thursday, October 27 -- Friday, October 28 -- Appendix C Workshop Groups -- Appendix D PHYSICIAN PAYMENT PLANNING GROUP.