Library Collections: Document: Full Text

(2) Freedom should be given to all legally qualified practitioners who subscribe to necessary rules of procedure to engage in insurance practice; freedom to all persons to choose their physician from among all local practitioners who engage in insurance practice; and freedom to each insurance practitioner to accept or reject insured persons who choose him;

(3) Freedom should be given the insurance practitioner to engage in private non-insurance practice to the extent that it does not interfere with his obligations to insurance patients;

(4) Adequate provisions should be made for opportunities or requirements for periodic post-graduate study by insurance practitioners or for other procedures designed constantly to maintain and elevate the quality of medical practice among insured persons;

(5) The system of payment for professional services should be sufficiently flexible to provide for payment on a fee, salary, or capitation basis as may be required: (a) by the conditions of a given locality or (2) by the characteristics of various types of medical services;

(6) The system of remuneration should provide incentives for: (a) the maintenance of high standards of quality) (b) the provision of prompt and efficient care, (c) the encouragement of coordinated interrelations among practitioners and institutions; and (d) the prevention of disease;

(7) The state medical authority in collaboration with the state administrative authority should draw up schedules for fees, salaries and capitation, as a basis for the remuneration of general practitioners, and may include different rates applying to different sized communities; or maximum or minimum rates;

(8) The general practitioners of a district who have accepted insurance practice should have the right to select that form of remuneration which they prefer, subject to the approval by the state medical and the state administrative authority;

(9) The state authorities should prescribe maximum limits to the numbers cf potential patients which any insurance practitioner may accept. Such limits may be so specified as to differ according to the conditions in different sections or types of communities within a state; since in some areas a limit as low as 500 or 600 might be appropriate, whereas a limit as high as 2,000 might be necessary in other areas;

(10) The state medical authority should prepare a list of services which are regarded as specialist services. The local medical authorities should prepare lists of physicians regarded as capable of rendering these various types of services from among those physicians who express desire to render such. These lists should be approved by the state medical authority. Flexibility is necessary since in small communities the same standards cannot be applied for admitting a physician to a list qualified to render certain specialist services, as would be applied in a large city. In the adoption of standards by a State, recognition should be given to standards established by approved national professional associations;

(11) In general; the plan of payment for the specialist should be on the basis of fees for services rendered or on a salary basis for a given amount of time;

(12) In determining the method of payment adopted for specialists the administrative authority should be responsible for selecting that method which (a) will yield a quality of service satisfactory to the medical authority, and (b) will be most economical in cost. The medical authority (primarily local with appeal when necessary to state medical authority) should be responsible for passing on quality of service rendered, not on method of payment. A given method of payment, if claimed by a medical group to involve or lead to unsatisfactory service, should be reconsidered by the final administrative authority;

(13) (Salary Basis). A schedule for the full or part-time employment of physicians on a salary basis for rendering specialist services should be drawn un by the state medical authority and may include different rates) applying to different sized communities: or maximum and minimum rates. Local medical authorities should present proposals for the rates which may be applicable to their areas, which are to be approved for these particular localities by the state medical authority and by the state administrative authority before becoming effective;

(14) (Fee Basis). A schedule of fees for various specialist services should be prepared by the state medical authority, and my include different rates, applicable to different sized communities, or maximum and minimum rates. Local medical authorities should present proposals for the rates to be applicable to their areas, which are to be approved by the state medical authority and by the state administrative authority before becoming effective.

(15) Fees to specialists may be paid to individual physicians for services rendered under the local schedule, or may be paid under a group plan. Under the latter plan, a total sum should be agreed upon by the local administrative and the local medical authority, to be applied to the payment for specialist services to be rendered by a designated body of physicians; and this lump sum should be paid to the physicians concerned to the amount and nature of the services rendered according to the locally applicable schedule.