Panel 5 — The End of Fee-for-Service?

This panel pulls together the payment material from the last couple of classes, so the book chapter and the Physician Agency and Payment Models slides are the place to review. Here’s a list of questions to think about as you prepare. There’s nothing to turn in — the questions I put to the panel come from this list.

From the reading

You can find these in the chapter and slides.

  1. How do fee-for-service and capitation differ in what they actually pay a physician for?
  2. What incentive does each model create — where does fee-for-service push toward more care, and where does capitation push toward less?
  3. How does physician agency interact with each payment model?
  4. What lies beyond simple fee-for-service versus capitation (blended payment, pay-for-performance), and what problem is each meant to solve?
  5. What does the evidence suggest about how physicians actually respond to payment incentives?

Bigger questions

No single right answer here — these are the ones we’ll talk through together.

  1. If fee-for-service rewards volume and capitation rewards holding back, is there a payment system that gets the incentives right? What would it look like?
  2. People have predicted “the end of fee-for-service” for years. Why do you think it has stuck around?
  3. Who would a shift away from fee-for-service help, and who might it hurt?
  4. Would you trust your own doctor more or less if you knew they were paid a flat amount per patient rather than per service?
  5. Can payment design alone fix overtreatment, or does it just move the problem somewhere else?

Your take

Do you know how your own doctor, or a family member’s, gets paid — and does knowing change how you feel about their advice? Anything from your own experience is welcome.

Beyond the textbook

Not required, but they’ll make the discussion current — skim one or two.