This conflict of interest is inherent to fee for service medicine.
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Other experiments try moving medicine away from fee-for-service payment altogether.
The widespread replacement of fee-for-service medicine with managed care led to a period of much lower health care cost growth.
In addition, doctors and hospitals need to move away from fee-for-service medicine so they have further incentives to operate more efficiently and therefore improve their health IT.
Both are radical departures from fee-for-service medicine in that medical care providers are banding together through their practice, clinic or a business umbrella like an ACO to manage populations of patients.
Yet writers in the issue also warn that fee-for-service medicine is not yet dead and it may be here to stay, particularly in the Medicare program where more payment reforms are needed.
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With employers unwilling or unable to spend more on medical care and Congress and the White House facing rising deficits and the so-called fiscal cliff, ACOs are becoming an important option over costly fee-for-service medicine.
Whether it is through an accountable care organization (ACO) or bundled payment to a patient-centered medical home, insurance companies and government health programs like Medicare are moving toward so-called value-based payment systems and away from fee-for-service medicine.
And they continue to measure health care against the golden age of fee-for-service medicine, when they could see specialists without the bother of getting a referral from their primary physicians, and when their hapless employers simply picked up the tab.
The clinic is run on a voluntary basis and charges Western clients a fee for consultation and medicine, in order to provide a free service for the Nepalis.
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