What Doctors Want: A Comment on the Financial Preferences of Organized Medicine

Abstract

Organized medicine’s persistent demand for high payments is one factor that contributes to the rising costs of health care. The profession’s longstanding preference for private and fee-for-service practice has pressured payers to increase reimbursement rates in fee-based systems; and it has stalled, thwarted, or otherwise co-opted attempts to contain costs in other payment systems. Yet what doctors want in fact varies. This comment revisits classic comparative studies of organized medicine in the advanced democracies to highlight two underemphasized findings: (1) physicians’ financial preferences can deviate from traditional expectations, and (2) the structure of the organizations that represent doctors can shape whether and how those preferences are expressed. These findings remain relevant today, as a discussion of contemporary American health politics illustrates.

How Ideas and Institutions Shape the Politics of Public Policy

“…Probably more typical is the situation described by Morgan and Campbell (2011): In a "delegated welfare state" with a strong role for private providers, those providers may provide additional allies for a policy's creation and are unlikely to be actively hostile to a program, but they may be opposed to further expansion of a program if it they believe that doing so means losing autonomy in the way they operate or a less generous financing arrangement, as has historically been the case with physicians in the United States with the expansion of government-provided health insurance. How and how well providers are organized can also affect their ability to press for types of program expansions they favor and block program retrenchment or transformation that they oppose (Perera 2020(Perera , 2021b. Having strong political leverage (e.g., teachers unions in off-cycle elections in the United States) can also mediate the strength of providers' influence on subsequent policy (Anzia 2011).…”

“…The same is true of research on the effects of policy feedback on policy stasis and change outside of the United States. More of such research is needed, especially explicitly comparative cross-national research (for examples, see e.g., Hacker 1998;Karapin 2014;Perera 2021b).…”

Increasing Trend of Studying Abroad for Residency Training Among Medical Students

“…This journey, which varies by country and lasts 6 to 12 years of training, requires physicians to complete extensive theoretical and practical training and pass numerous exams in order to become specialists (Nara et al, 2011). Under such conditions, it’s natural for physicians to have higher expectations than the general population, the majority of which revolve around a higher salary (Perera, 2021), increased recognition, and a better standard of living (Sheikh et al, 2012).…”