October 17, 2007

Is P4P Really FFS?

Author Affiliations

Author Affiliations: Departments of Health Policy, Management, and Evaluation (Drs Wodchis and Detsky) and Medicine (Dr Detsky), University of Toronto, Toronto Rehabilitation Institute, Institute for Clinical Evaluative Sciences (Dr Wodchis), and Department of Medicine, Mount Sinai Hospital and University Health Network (Dr Detsky), Toronto, Ontario, Canada; Departments of Geriatrics and Adult Development and Medicine, Mount Sinai School of Medicine, New York, New York, and Health Services Research and Development Targeted Research Enhancement Program and Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, New York (Dr Ross).

JAMA. 2007;298(15):1797-1799. doi:10.1001/jama.298.15.1797

It is common for societal trends and preferences to be recycled. Men's neckties have varied from thin to wide and back to thin again. Government policies have favored individual responsibility, then social responsibility, and again individual responsibility. In health care, policy makers have swung between concern about access and concern about cost, attempting to increase or decrease medical care supply in response. Until 1980, there was widespread belief in a fairly severe physician shortage in Canada and the United States. By 1990, it was thought that too many physicians were performing too many services. Now, in the 2000s, physician shortages are again the topic of discussion.

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