Talk:Fee-for-service

Biased article
"When bills are paid under FFS by a third party, patients (along with doctors) have no incentive to consider the cost of treatment."

This line in the article underscores the entire premise of this very slanted article. However, instead of placing this in context, the article presents the idea of paying for individual services as the 'demon' in health care. We pay for individual items in almost every other aspect of life, yet for some reason this article is trying to tell us when it comes to our health, this model that works well for every other transaction doesn't work in health care. The only passing mention of why is the line I quote above. Clearly this article needs a LOT of work, and I'm surprised it ended up on the front page of Wikipedia. -- Avanu (talk) 07:56, 11 July 2011 (UTC)


 * Suggestion of a line of thought to pursue. As I'm led to understand it, there's a simple reason that FFS can be a bad thing--it nets a hospital/physician more money to perform a procedure to correct a health issue than to give a consulting session to a patient so that the issue can be caught and prevented before it happens. Many physicians can consult, but only specialists can perform corrective procedures, thus the cost of the procedure is much higher.


 * So, look at it this way: as a physician, would you rather receive money for performing a consult with a patient, or receive 10 or 100 times as much money from performing a procedure on them? I believe the comparison can be made with nursing staff, who are salaried; no matter how many patients they care for, they get paid the same, so their primary goal is to perform the most efficient care possible. The physician, on the other hand, gets paid more for performing more procedures, so their primary goal is to perform as many procedures as can be justified. Exaggeration? Sure, but this effect (in theory) is still demonstrated across the board. I'd recommend starting the evidence hunt at this point. CarpeGuitarrem (talk) 21:24, 28 August 2012 (UTC)


 * You're right that FFS is common. But is there another sector that combines FFS with a third party payer (and opaque prices)? I'm unaware of one. The sentence, from the source, says, "The combination of insurance and fee-for-service can be wasteful because neither the patient nor the physician has an incentive to consider cost." Do you think the sentence you quoted from the article misrepresents the source text?


 * If the article comes off to some as critical of FFS in health care, maybe it should, in order to be neutral, because Chernew (who is cited in the article) writes "the FFS system has come under attack lately as a primary contributor to the ills of the American health care system". In general, for one to perceive a NPOV problem, wouldn't one need a general knowledge of the reliable sources in that area and understanding of the sources that the article cites or evidence article text deviates from source text? I don't think the concern expressed above meets either of those criteria. Please correct me if I am misunderstanding something with NPOV policy.


 * In regards to general article improvement, you think the article does not explain why some think FFS is not ideal as a health care payment model? I disagree. Did you read the rest of the article or did you stop at the sentence you quoted? Thanks. Jesanj (talk) 21:06, 12 July 2011 (UTC)


 * Also, your post makes me think you're confounding neutrality and bias; "the NPOV policy says nothing about objectivity". Jesanj (talk) 03:24, 13 July 2011 (UTC)


 * What is the alternative to having a specific price for a specific service (or set of services)? Totally free? Or totally covered by a flat rate?   Both of those would definitely suffer from the same problem as mentioned in the sentence I quoted above.  The problem with this article is that it links a third-party payer with the concept of individual pricing as an inextricably linked duo.  However it lays all the blame on individual pricing, not the fact that someone else is picking up the bill.


 * If you took a somewhat poor-mannered friend out to eat, and said 'get whatever you like', they would order the steak and lobster along with champagne and the best house dessert. Is the friend to blame for not being better mannered?  Or is the restaurant to blame for not asking the friend to get fewer or cheaper items?  Really the blame lays on you for offering such a thing in the first place.  And so the same is the case with this article.  If someone else obscures the price, why should the consumer be expected to choose based on market forces?  Almost everyone operates in their own self interest in normal life, and altruistically when they can afford to be.


 * The real point is, the article emphasizes individualized pricing as the problem, when it isn't the problem at all. -- Avanu (talk) 03:24, 13 July 2011 (UTC)


 * I think I understand what would fix the problem you see. And I'd be happy to make more it clear that the third party payer encourages overindulgence on the part of the patient. However, I don't understand what you mean when you say the article "links a third-party payer with the concept of individual pricing..." Jesanj (talk) 03:54, 13 July 2011 (UTC)


 * In actuality, doesn't "individual pricing" = "fee-for-service" ?
 * Yet, currently doesn't this article essentially say "fee-for-service" = "individual pricing" + "third party payer" ?
 * (to explain further, my understanding of individual pricing is like what you might see at the grocery store for a box of corn flakes versus a box of raisin bran or anything else on the shelves, in the context of health care, this might be $100 to pull a tooth, or $50 to wrap a toe in bandages.) -- Avanu (talk) 03:59, 13 July 2011 (UTC)
 * Perhaps a sentence like this would be useful: While while most of health care payments are done under insurance, a minority of FFS payments are made by patients themselves. Jesanj (talk) 04:03, 13 July 2011 (UTC)


 * The article itself presents this: "Pay for performance is an emerging movement in health insurance (initially in Britain and United States). Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment." -- my emphasis added. In normal markets, a consumer would demand to pay less (or shop elsewhere) if an inferior product were provided.  This article is premised on a non-free-market scenario, but it doesn't make this clear to the reader. -- Avanu (talk) 04:15, 13 July 2011 (UTC)


 * This sort of thing works itself out automatically in free markets, where people shop around, compare prices, and find deals or specials. Vendors are encouraged to set bargains or compete against other vendors as well.  I see a huge bias in this article and its counterpoint because both are presenting these very artificial replacements as the good and the bad, when people figured out in antiquity how to set prices.  I realize that at times, fixing one's personal health can outweigh all other considerations and we might be tempted to pay any price to stay alive, but simple price-gouging controls would suffice, I would think. -- Avanu (talk) 04:20, 13 July 2011 (UTC)

Interesting Links
Market Forces And Efficient Health Care Systems - 2004

''The "market forces" to which economists ascribe the ability to motivate improvement in quality and efficiency are largely nonexistent in U.S. health care. One thus might ask, "Could market forces be made strong enough to deliver efficient health care systems?" There is some evidence to suggest that the answer is "Yes."''

http://content.healthaffairs.org/content/23/2/25.full

CONTAINING MEDICAL CARE COSTS THROUGH MARKET FORCES - 1982

''In response to the problem of rising medical care costs in general, and their effects on the federal budget in particular, some in the Congress have proposed a change in policy that would stress greater reliance on the market to allocate resources to medical care. Its advocates believe that this would foster increased competition among the providers of services.''

http://www.cbo.gov/doc.cfm?index=5331&type=0

'''Who Is Responsible for the Common Good in a Competitive Market? - 1999'''

''the nation embraced competition in the marketplace as the way to manage growing problems with cost and quality. Regardless of whether the marketplace will provide a lasting solution to cost and quality problems, it is not designed to deal with some important aspects of health care as a whole.''

http://jama.ama-assn.org/content/281/12/1127.extract


 * And one that mentions cost-sharing. Jesanj (talk) 04:43, 13 July 2011 (UTC)
 * "When people are insulated from the cost of a desirable product or service, they use more" -- giant 'duh' there. :) -- Avanu (talk) 04:51, 13 July 2011 (UTC)

thought this was interesting: http://www.medscape.com/viewarticle/748385?sssdmh=dm1.712449&src=nldne — Preceding unsigned comment added by 24.236.106.127 (talk) 01:05, 30 September 2011 (UTC)

Category:Unnecessary health care
A user reverted my addition of Category:Unnecessary health care this this article on "fee-for-service", saying "a fee for service system can exist without unnecessary care". I think that the sources may contradict this, and it might be the case that all the sources in this article only talk about the concept in the context of it causing "unnecessary health care". So far as I know, no one defends this system as granting less unnecessary health care than any other system.

I think that fee-for-service is a concept which may be intimately connected to the concept of unnecessary health care. Could someone check the sources and article content itself comment on the extent to which this may or may not be so?  Blue Rasberry   (talk)   14:09, 6 October 2013 (UTC)

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