In the past, physicians set the American health care agenda, but the transformation of the U.S. health care system over the past decade has seen a decline in their influence. Insurers have gained a large control over health care, and their interests often are not the same as physicians. Also, physicians are more dependent on government reimbursement than they have ever been. Furthermore, with the proliferation of health interest groups, doctors often must fight hard to be heard.
The future role of physicians will be shaped by mastery over niches where they have the capacity and interest in leading change, assert Miriam J. Laugesen and Thomas Rice of the University of California, Los Angeles, in a recent commentary. These areas include payment policy, quality and clinical innovation, and medical education and training. For example, while the Centers for Medicare & Medicaid Services (CMS) sets the overall price for medical services, the American Medical Association has a large degree of influence over the value of the codes (multiplied by dollars to arrive at payments) listed in the Medicare Fee Schedule. The CMS has followed the AMA committee's recommendations over 90 percent of the time. The value of the codes, which has increased over time, is important because it represents about half of the final physician payment.
In the quality arena, physicians have taken the lead in the development of effectiveness research and clinical practice guidelines. Physician education and training represent another area where physicians clearly have an important role to play and which they are unlikely to cede to others. However, those who finance education (private payers and governments) are likely to extend their scrutiny of this area as a means of controlling expenditures.
See "Is the doctor in? The evolving role of organized medicine in health policy," by Miriam Laugesen and Thomas Rice, in the April 2003 Journal of Health Politics, Policy and Law 28, pp. 289-316.