THE PEDIATRICIAN AND THE PUBLIC

Abstract

1. Payment for the services of physicians conducting diagnostic clinics is made most frequently by allowing flat rates, either per unit of time or per clinic session, somewhat less frequently by using the part-time salary system, and only rarely on the basis of the fee-for-service system. 2. Payment for specialist consultations outside of clinics is based on the fee-for-service system and the part-time salary system in this order of frequency. 3. Payment for treatment by physicians, both specialists and general physicians, is made most frequently on the basis of the fee-for-service system and less frequently on the basis of the part-time salary system. 4. In at least eight states, the part-time salaries paid to the physicians cover a varying combination of the following types of professional service: diagnostic clinic sessions, consultations outside of clinics, and treatment, including preoperative and postoperative care as well as operative procedures. 5. Dentists, including orthodontists, are compensated on the basis of the fee-for-service system in the great majority of all states. 6. Pediatricians receive fees most frequently and flat rates or part-time salaries less frequently. Orthopedic surgeons are paid on the basis of the flat rate system, the fee-for-service system, or the part-time salary system in this order of frequency. 7. Reimbursement of travel expenses incurred in connection with both service at diagnostic field clinics and consultations outside of clinics is a widely accepted principle. 8. There is little, if any, information on such questions as the reasons for the choice of certain methods of payment, the basis for the determination of specific rates of compensation, the number of diagnostic clinic sessions actually held per month or year, the average number of hours, excluding travel time, actually spent on one clinic session, the amount of work and time actually contributed by the physicians receiving part-time salaries, or the type and amount of service rendered by physicians compensated on the basis of the fee-for-service system. In the absence of such information no conclusions can be drawn on the relative merits of the various payment methods employed and especially on the adequacy of the compensation received by the participating physicians and dentists, the effect on the quality of service, and the administrative implications.