Government participation in physician negotiations in German economic policy as applied to universal health care coverage in the United States

Abstract

Systems of universal health care coverage in western industrial societies have usually established some form of government participation in negotiations over physician payment as a means of controlling costs. In the Federal Republic of Germany, a mixed private and public body. Concerted Action in Health Care sets a ‘target’ for physician and ‘sickness fund’ negotiators. This indirect form of government participation is effective in ‘linking’ fees with utilization during negotiations, avoiding inflationary trends inherent in fee-for-service systems. This target-setting factor is a necessary complement to negotiation of a ‘pool’ of money, wage level and technological adjustment factors, as contained in a model of German economic health care policy. These four elements of economic policy are recommended as cost control measures for office-based physician payments under conditions of universal health care coverage in the United States. Indirect government participation through setting ‘targets’ for negotiations is seen as consistent with estab;ished American institutional practices.