CDZ A Brief History of Physician Remuneration

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In the general prologue of The Canterbury Tales, Geoffrey Chaucer describes physicians as having a “special love for gold.” Since well before Chaucer’s time, the issue of physician remuneration has been discussed, with the debate continuing today. The earliest evidence of this issue is in the Code of Hammurabi from around 1750 BC. Hippocrates, Plato, and Galen discussed remuneration, and it was an issue in Jewish and Islamic culture too. During the last few centuries, issues around physician remuneration have continued to be discussed.

Probably the oldest extant primary source of medical fees is the code of Hammurabi. Written about 2000 B.C., the code is a set of laws decreed by King Hammurabi of Babylon. There are several references to physicians, including how they should be paid for their services. For example, sections 215-217 of the code read:
In medieval Europe, some physicians were employed by royalty and attended to the health of the royal court and perhaps some of its subjects, others were paid by the church to treat the sick of the parish and the poor. Some city states such as Venice employed physicians to give free treatment to the poor, treat the rich at reduced rates and advise the state on medical-legal and public health matters.

There are many sources from America which record how physicians were paid and whether fees were regulated or not. One example is the regulation of fees in Boston starting in 1780. It was the Boston Medical Society which developed the fee bill in order to stop physicians from undercutting each other. The fees on the fee bills were minimums so physicians could charge more, but no less. In addition, patients only wanted to pay for services if it included treatment such as a drug or a procedure. The fee bill however stipulated that charges be made for all visits. Because the physicians were controlling the fees, they made sure that they were always very well compensated, their general policy being to increase fees in good economic times but not to lower them in hard economic times. Between 1795 and 1806 the cost of living changed very little but the fees increased by 50-60%.

In Boston, we see an example where the physicians controlled their own remuneration and thus sometimes charged quite high amounts for their services. In South Carolina in 1844, we have an example of quite the opposite. The St. Peter’s parish, like the whole state, was very poor so the local officials decided to set a fee bill to curb the “exorbitant, oppressive” physician fees which “unjustly absorbs so large a portion of [the farmers] hard earned incomes.

If we compare the fees in Boston and South Carolina, we can see the vast difference in fees when physicians or the community set them. In Boston in 1806, a regular single visit was $1.50, normal obstetrical delivery was $12.00, treating gonorrhea was $10.00 and the fee for amputating a leg was set at $40.00. In South Carolina, almost three decades later in 1844, a regular single visit was no charge, normal obstetrical delivery was $3.00, treating gonorrhea was $2.00 and the fee for amputating a leg was set at $5.00.

The advancing settlement of America westward necessitated innovative solutions for physician remuneration due to low populations and poor patients. For example, a physician only agreed to move to Tucson, Arizona in 1871 after twenty-five families agreed to pay him $100 a year for his services. The frontier medical practice also required novel ways of payment such as poultry, cattle, tobacco, fruit, vegetables, wood and clothes. Barter was also a common payment method in Australia.

The very first physicians were military and naval surgeons and so would have been paid as salaried practitioners. As free settlers came though, “civilian” physicians would need to be paid and payment with goods and services would have been acceptable because the early Australian physician would have few places to spend his money. By the middle of the nineteenth century there are examples of fee regulation in Australia. The Port Philip Medical Association set fees for three different classes of patient with different fees for different classes. The 1st class patients (i.e. rich patients) had to pay two to five times as much as 3rd class (i.e. poor patients) for the same treatment.

From the very earliest of recorded history in the code of Hammurabi to the present day, we can find records of physician remuneration. It was an important matter of debate in medical texts as well as non-medical writings from Aristophanes’ and Sophocles’ plays as mentioned above to Moliere’s “Le Malade imaginare” and George Bernard Shaw’s “The Doctor’s Dilemma”. For the subject to be found throughout recorded history -- medical and nonmedical -- the issue must have been important, as it is today. Perhaps, some ideas to help us fix our current problems can be found in the past.

Additional Reference:
 
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BULLDOG

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Doctors certainly deserve fair compensation, and nobody wants a surgeon to have to worry about feeding his family, but a medical degree shouldn't be a license to gouge their patients.
 

numan

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Doctors certainly deserve fair compensation, and nobody wants a surgeon to have to worry about feeding his family, but a medical degree shouldn't be a license to gouge their patients.
However, in fact, it is a license to gouge their patients.

Long live Big Pharma and the Medical Mafia!!

AMA utopia will be achieved when everyone is sick from cradle to grave and paying for the most expensive poisonous drugs that medical ingenuity can invent. --- :(
.
 

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In the general prologue of The Canterbury Tales, Geoffrey Chaucer describes physicians as having a “special love for gold.” Since well before Chaucer’s time, the issue of physician remuneration has been discussed, with the debate continuing today. The earliest evidence of this issue is in the Code of Hammurabi from around 1750 BC. Hippocrates, Plato, and Galen discussed remuneration, and it was an issue in Jewish and Islamic culture too. During the last few centuries, issues around physician remuneration have continued to be discussed.

Probably the oldest extant primary source of medical fees is the code of Hammurabi. Written about 2000 B.C., the code is a set of laws decreed by King Hammurabi of Babylon. There are several references to physicians, including how they should be paid for their services. For example, sections 215-217 of the code read:
In medieval Europe, some physicians were employed by royalty and attended to the health of the royal court and perhaps some of its subjects, others were paid by the church to treat the sick of the parish and the poor. Some city states such as Venice employed physicians to give free treatment to the poor, treat the rich at reduced rates and advise the state on medical-legal and public health matters.

There are many sources from America which record how physicians were paid and whether fees were regulated or not. One example is the regulation of fees in Boston starting in 1780. It was the Boston Medical Society which developed the fee bill in order to stop physicians from undercutting each other. The fees on the fee bills were minimums so physicians could charge more, but no less. In addition, patients only wanted to pay for services if it included treatment such as a drug or a procedure. The fee bill however stipulated that charges be made for all visits. Because the physicians were controlling the fees, they made sure that they were always very well compensated, their general policy being to increase fees in good economic times but not to lower them in hard economic times. Between 1795 and 1806 the cost of living changed very little but the fees increased by 50-60%.

In Boston, we see an example where the physicians controlled their own remuneration and thus sometimes charged quite high amounts for their services. In South Carolina in 1844, we have an example of quite the opposite. The St. Peter’s parish, like the whole state, was very poor so the local officials decided to set a fee bill to curb the “exorbitant, oppressive” physician fees which “unjustly absorbs so large a portion of [the farmers] hard earned incomes.

If we compare the fees in Boston and South Carolina, we can see the vast difference in fees when physicians or the community set them. In Boston in 1806, a regular single visit was $1.50, normal obstetrical delivery was $12.00, treating gonorrhea was $10.00 and the fee for amputating a leg was set at $40.00. In South Carolina, almost three decades later in 1844, a regular single visit was no charge, normal obstetrical delivery was $3.00, treating gonorrhea was $2.00 and the fee for amputating a leg was set at $5.00.

The advancing settlement of America westward necessitated innovative solutions for physician remuneration due to low populations and poor patients. For example, a physician only agreed to move to Tucson, Arizona in 1871 after twenty-five families agreed to pay him $100 a year for his services. The frontier medical practice also required novel ways of payment such as poultry, cattle, tobacco, fruit, vegetables, wood and clothes. Barter was also a common payment method in Australia.

The very first physicians were military and naval surgeons and so would have been paid as salaried practitioners. As free settlers came though, “civilian” physicians would need to be paid and payment with goods and services would have been acceptable because the early Australian physician would have few places to spend his money. By the middle of the nineteenth century there are examples of fee regulation in Australia. The Port Philip Medical Association set fees for three different classes of patient with different fees for different classes. The 1st class patients (i.e. rich patients) had to pay two to five times as much as 3rd class (i.e. poor patients) for the same treatment.

From the very earliest of recorded history in the code of Hammurabi to the present day, we can find records of physician remuneration. It was an important matter of debate in medical texts as well as non-medical writings from Aristophanes’ and Sophocles’ plays as mentioned above to Moliere’s “Le Malade imaginare” and George Bernard Shaw’s “The Doctor’s Dilemma”. For the subject to be found throughout recorded history -- medical and nonmedical -- the issue must have been important, as it is today. Perhaps, some ideas to help us fix our current problems can be found in the past.

Additional Reference:
In the 1700s, physicians KNEW what their services and supplies cost. They had no excuse. But today, you ask a doc "what it costs" and they are completely clueless. Kinda hard to shaft the public if you TRULY don't KNOW what you are charging. That patient-doctor relationship has been usurped by a HUGE wad of scum-sucking middle men. Not the LEAST of which are the Armies of faceless, unaccountable Govt. bureaucrats.

Look "elsewhere" for 21st "medical inflation". Most of it just the inability of Govt to stay ahead of techniques and practices.
 
OP
320 Years of History

320 Years of History

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In the general prologue of The Canterbury Tales, Geoffrey Chaucer describes physicians as having a “special love for gold.” Since well before Chaucer’s time, the issue of physician remuneration has been discussed, with the debate continuing today. The earliest evidence of this issue is in the Code of Hammurabi from around 1750 BC. Hippocrates, Plato, and Galen discussed remuneration, and it was an issue in Jewish and Islamic culture too. During the last few centuries, issues around physician remuneration have continued to be discussed.

Probably the oldest extant primary source of medical fees is the code of Hammurabi. Written about 2000 B.C., the code is a set of laws decreed by King Hammurabi of Babylon. There are several references to physicians, including how they should be paid for their services. For example, sections 215-217 of the code read:
In medieval Europe, some physicians were employed by royalty and attended to the health of the royal court and perhaps some of its subjects, others were paid by the church to treat the sick of the parish and the poor. Some city states such as Venice employed physicians to give free treatment to the poor, treat the rich at reduced rates and advise the state on medical-legal and public health matters.

There are many sources from America which record how physicians were paid and whether fees were regulated or not. One example is the regulation of fees in Boston starting in 1780. It was the Boston Medical Society which developed the fee bill in order to stop physicians from undercutting each other. The fees on the fee bills were minimums so physicians could charge more, but no less. In addition, patients only wanted to pay for services if it included treatment such as a drug or a procedure. The fee bill however stipulated that charges be made for all visits. Because the physicians were controlling the fees, they made sure that they were always very well compensated, their general policy being to increase fees in good economic times but not to lower them in hard economic times. Between 1795 and 1806 the cost of living changed very little but the fees increased by 50-60%.

In Boston, we see an example where the physicians controlled their own remuneration and thus sometimes charged quite high amounts for their services. In South Carolina in 1844, we have an example of quite the opposite. The St. Peter’s parish, like the whole state, was very poor so the local officials decided to set a fee bill to curb the “exorbitant, oppressive” physician fees which “unjustly absorbs so large a portion of [the farmers] hard earned incomes.

If we compare the fees in Boston and South Carolina, we can see the vast difference in fees when physicians or the community set them. In Boston in 1806, a regular single visit was $1.50, normal obstetrical delivery was $12.00, treating gonorrhea was $10.00 and the fee for amputating a leg was set at $40.00. In South Carolina, almost three decades later in 1844, a regular single visit was no charge, normal obstetrical delivery was $3.00, treating gonorrhea was $2.00 and the fee for amputating a leg was set at $5.00.

The advancing settlement of America westward necessitated innovative solutions for physician remuneration due to low populations and poor patients. For example, a physician only agreed to move to Tucson, Arizona in 1871 after twenty-five families agreed to pay him $100 a year for his services. The frontier medical practice also required novel ways of payment such as poultry, cattle, tobacco, fruit, vegetables, wood and clothes. Barter was also a common payment method in Australia.

The very first physicians were military and naval surgeons and so would have been paid as salaried practitioners. As free settlers came though, “civilian” physicians would need to be paid and payment with goods and services would have been acceptable because the early Australian physician would have few places to spend his money. By the middle of the nineteenth century there are examples of fee regulation in Australia. The Port Philip Medical Association set fees for three different classes of patient with different fees for different classes. The 1st class patients (i.e. rich patients) had to pay two to five times as much as 3rd class (i.e. poor patients) for the same treatment.

From the very earliest of recorded history in the code of Hammurabi to the present day, we can find records of physician remuneration. It was an important matter of debate in medical texts as well as non-medical writings from Aristophanes’ and Sophocles’ plays as mentioned above to Moliere’s “Le Malade imaginare” and George Bernard Shaw’s “The Doctor’s Dilemma”. For the subject to be found throughout recorded history -- medical and nonmedical -- the issue must have been important, as it is today. Perhaps, some ideas to help us fix our current problems can be found in the past.

Additional Reference:
In the 1700s, physicians KNEW what their services and supplies cost. They had no excuse. But today, you ask a doc "what it costs" and they are completely clueless. Kinda hard to shaft the public if you TRULY don't KNOW what you are charging. That patient-doctor relationship has been usurped by a HUGE wad of scum-sucking middle men. Not the LEAST of which are the Armies of faceless, unaccountable Govt. bureaucrats.

Look "elsewhere" for 21st "medical inflation". Most of it just the inability of Govt to stay ahead of techniques and practices.
Red:
I expect that's so for doctors on staff in hospitals and who are answering that question with regard to what the hospital charges for their services. (Many doctors work at hospitals, but aren't employed by the hospital.) It's no different than the junior level consultants on my project teams who've never been part of the proposal or billing process. They know only what they get paid, not what the firm bills clients for their labors.

Doctors in private practice know exactly what their billing rates are. That too is similar to my own situation as a consultant. I know exactly what my standard ("rack") rate is, what my average bill rate across all my clients (thus my average realization rate), and what my specific rate is on any given engagement.
 

2aguy

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And as you sit in the waiting room as the Doctor works to save the life of your child...and you swear to whatever you believe that you would give anything, do anything if only the Doctor can save their lives...and then...when the Doctor succeeds..........you sit their and dick with him over the bill.........

That is a big problem.....
 

flacaltenn

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In the general prologue of The Canterbury Tales, Geoffrey Chaucer describes physicians as having a “special love for gold.” Since well before Chaucer’s time, the issue of physician remuneration has been discussed, with the debate continuing today. The earliest evidence of this issue is in the Code of Hammurabi from around 1750 BC. Hippocrates, Plato, and Galen discussed remuneration, and it was an issue in Jewish and Islamic culture too. During the last few centuries, issues around physician remuneration have continued to be discussed.

Probably the oldest extant primary source of medical fees is the code of Hammurabi. Written about 2000 B.C., the code is a set of laws decreed by King Hammurabi of Babylon. There are several references to physicians, including how they should be paid for their services. For example, sections 215-217 of the code read:
In medieval Europe, some physicians were employed by royalty and attended to the health of the royal court and perhaps some of its subjects, others were paid by the church to treat the sick of the parish and the poor. Some city states such as Venice employed physicians to give free treatment to the poor, treat the rich at reduced rates and advise the state on medical-legal and public health matters.

There are many sources from America which record how physicians were paid and whether fees were regulated or not. One example is the regulation of fees in Boston starting in 1780. It was the Boston Medical Society which developed the fee bill in order to stop physicians from undercutting each other. The fees on the fee bills were minimums so physicians could charge more, but no less. In addition, patients only wanted to pay for services if it included treatment such as a drug or a procedure. The fee bill however stipulated that charges be made for all visits. Because the physicians were controlling the fees, they made sure that they were always very well compensated, their general policy being to increase fees in good economic times but not to lower them in hard economic times. Between 1795 and 1806 the cost of living changed very little but the fees increased by 50-60%.

In Boston, we see an example where the physicians controlled their own remuneration and thus sometimes charged quite high amounts for their services. In South Carolina in 1844, we have an example of quite the opposite. The St. Peter’s parish, like the whole state, was very poor so the local officials decided to set a fee bill to curb the “exorbitant, oppressive” physician fees which “unjustly absorbs so large a portion of [the farmers] hard earned incomes.

If we compare the fees in Boston and South Carolina, we can see the vast difference in fees when physicians or the community set them. In Boston in 1806, a regular single visit was $1.50, normal obstetrical delivery was $12.00, treating gonorrhea was $10.00 and the fee for amputating a leg was set at $40.00. In South Carolina, almost three decades later in 1844, a regular single visit was no charge, normal obstetrical delivery was $3.00, treating gonorrhea was $2.00 and the fee for amputating a leg was set at $5.00.

The advancing settlement of America westward necessitated innovative solutions for physician remuneration due to low populations and poor patients. For example, a physician only agreed to move to Tucson, Arizona in 1871 after twenty-five families agreed to pay him $100 a year for his services. The frontier medical practice also required novel ways of payment such as poultry, cattle, tobacco, fruit, vegetables, wood and clothes. Barter was also a common payment method in Australia.

The very first physicians were military and naval surgeons and so would have been paid as salaried practitioners. As free settlers came though, “civilian” physicians would need to be paid and payment with goods and services would have been acceptable because the early Australian physician would have few places to spend his money. By the middle of the nineteenth century there are examples of fee regulation in Australia. The Port Philip Medical Association set fees for three different classes of patient with different fees for different classes. The 1st class patients (i.e. rich patients) had to pay two to five times as much as 3rd class (i.e. poor patients) for the same treatment.

From the very earliest of recorded history in the code of Hammurabi to the present day, we can find records of physician remuneration. It was an important matter of debate in medical texts as well as non-medical writings from Aristophanes’ and Sophocles’ plays as mentioned above to Moliere’s “Le Malade imaginare” and George Bernard Shaw’s “The Doctor’s Dilemma”. For the subject to be found throughout recorded history -- medical and nonmedical -- the issue must have been important, as it is today. Perhaps, some ideas to help us fix our current problems can be found in the past.

Additional Reference:
In the 1700s, physicians KNEW what their services and supplies cost. They had no excuse. But today, you ask a doc "what it costs" and they are completely clueless. Kinda hard to shaft the public if you TRULY don't KNOW what you are charging. That patient-doctor relationship has been usurped by a HUGE wad of scum-sucking middle men. Not the LEAST of which are the Armies of faceless, unaccountable Govt. bureaucrats.

Look "elsewhere" for 21st "medical inflation". Most of it just the inability of Govt to stay ahead of techniques and practices.
Red:
I expect that's so for doctors on staff in hospitals and who are answering that question with regard to what the hospital charges for their services. (Many doctors work at hospitals, but aren't employed by the hospital.) It's no different than the junior level consultants on my project teams who've never been part of the proposal or billing process. They know only what they get paid, not what the firm bills clients for their labors.

Doctors in private practice know exactly what their billing rates are. That too is similar to my own situation as a consultant. I know exactly what my standard ("rack") rate is, what my average bill rate across all my clients (thus my average realization rate), and what my specific rate is on any given engagement.
Not true that private practice doctors know much of ANYTHING about charges and costs. I know. I had my family under HSA plan for about 8 years. Since the 1st $6K was "self-funded" I'd shop around for docs who knew ANYTHING about costs and would discount for cash etc.. Very damn few can tell you.. Because EVERYONE gets a special deal nowadays. One price for MediCare, one price for Medicaid. Another price list for each separate insurer. The "RACK price" is just a fiction. Doctors NEVER get it. So no one should pay it or quote it or use it as propaganda. The only doctors who will regularly ALLOW staff to take a "wild ass stab" at costs are dermatologists..

My veterinarian makes more profit on a well visit or simple procedure than any of my doctors. After the govt and the insurance companies are done beating on them...
 

2aguy

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Here is the solution for you guys.....sacrifice the first 26 years or so of your life to becoming a Doctor.....and then specialize in neurosurgery or some other incredibly important, but very difficult branch of medicne...then open your own practice and charge 10 dollars an hour.....that should do the trick.....
 

2aguy

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Also...the problem I find with those on the left of the political spectrum when it comes to certain issues is this...they become focused only on what is immediately in front of their eyes......

You could look at the death penalty, abortion and other issues...but the issue we are dealing with is Doctors and how much they earn....

For some in this country they enter the examination room, the Doctor asks them some questions and they get a prescription and go home.....and they think....that guy is driving that expensive car, living in an expensive home and that is all he has to do?

And behind what they see in front of their eyes is the truth....to sit in that chair and write that prescription, let alone all the other specialties and services they do......is about 26 years of their lives devoted to little more than studying and working, long hours, to get to that chair.....they sacrifice a lot to get there....that we don't see because they do it long before we enter that exam room.......and that sacrifice gets second guessed by greedy people who want their medical care for free......
 

2aguy

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Here you go.....

How Long Does it Take to Become a Doctor? | Kaplan Test Prep

The timeline can seem daunting. Four years for medical school, a minimum of three years for residency, and a few more if you want to specialize with a fellowship. Combine that with an average starting age of 24 (or 26 for DO—doctor of osteopathic—applicants), and this means the vast majority of medical students don’t become independent physicians until their early 30s.

You don't get those years back.....they are gone....sacrificed in order to study and work to save lives........and you guys want to haggle over the bill......you want them to be government clock punchers......like the guy at the Post Office window...

Sorry, I like my doctors well rewarded for the work they do......
 
OP
320 Years of History

320 Years of History

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In the general prologue of The Canterbury Tales, Geoffrey Chaucer describes physicians as having a “special love for gold.” Since well before Chaucer’s time, the issue of physician remuneration has been discussed, with the debate continuing today. The earliest evidence of this issue is in the Code of Hammurabi from around 1750 BC. Hippocrates, Plato, and Galen discussed remuneration, and it was an issue in Jewish and Islamic culture too. During the last few centuries, issues around physician remuneration have continued to be discussed.

Probably the oldest extant primary source of medical fees is the code of Hammurabi. Written about 2000 B.C., the code is a set of laws decreed by King Hammurabi of Babylon. There are several references to physicians, including how they should be paid for their services. For example, sections 215-217 of the code read:
In medieval Europe, some physicians were employed by royalty and attended to the health of the royal court and perhaps some of its subjects, others were paid by the church to treat the sick of the parish and the poor. Some city states such as Venice employed physicians to give free treatment to the poor, treat the rich at reduced rates and advise the state on medical-legal and public health matters.

There are many sources from America which record how physicians were paid and whether fees were regulated or not. One example is the regulation of fees in Boston starting in 1780. It was the Boston Medical Society which developed the fee bill in order to stop physicians from undercutting each other. The fees on the fee bills were minimums so physicians could charge more, but no less. In addition, patients only wanted to pay for services if it included treatment such as a drug or a procedure. The fee bill however stipulated that charges be made for all visits. Because the physicians were controlling the fees, they made sure that they were always very well compensated, their general policy being to increase fees in good economic times but not to lower them in hard economic times. Between 1795 and 1806 the cost of living changed very little but the fees increased by 50-60%.

In Boston, we see an example where the physicians controlled their own remuneration and thus sometimes charged quite high amounts for their services. In South Carolina in 1844, we have an example of quite the opposite. The St. Peter’s parish, like the whole state, was very poor so the local officials decided to set a fee bill to curb the “exorbitant, oppressive” physician fees which “unjustly absorbs so large a portion of [the farmers] hard earned incomes.

If we compare the fees in Boston and South Carolina, we can see the vast difference in fees when physicians or the community set them. In Boston in 1806, a regular single visit was $1.50, normal obstetrical delivery was $12.00, treating gonorrhea was $10.00 and the fee for amputating a leg was set at $40.00. In South Carolina, almost three decades later in 1844, a regular single visit was no charge, normal obstetrical delivery was $3.00, treating gonorrhea was $2.00 and the fee for amputating a leg was set at $5.00.

The advancing settlement of America westward necessitated innovative solutions for physician remuneration due to low populations and poor patients. For example, a physician only agreed to move to Tucson, Arizona in 1871 after twenty-five families agreed to pay him $100 a year for his services. The frontier medical practice also required novel ways of payment such as poultry, cattle, tobacco, fruit, vegetables, wood and clothes. Barter was also a common payment method in Australia.

The very first physicians were military and naval surgeons and so would have been paid as salaried practitioners. As free settlers came though, “civilian” physicians would need to be paid and payment with goods and services would have been acceptable because the early Australian physician would have few places to spend his money. By the middle of the nineteenth century there are examples of fee regulation in Australia. The Port Philip Medical Association set fees for three different classes of patient with different fees for different classes. The 1st class patients (i.e. rich patients) had to pay two to five times as much as 3rd class (i.e. poor patients) for the same treatment.

From the very earliest of recorded history in the code of Hammurabi to the present day, we can find records of physician remuneration. It was an important matter of debate in medical texts as well as non-medical writings from Aristophanes’ and Sophocles’ plays as mentioned above to Moliere’s “Le Malade imaginare” and George Bernard Shaw’s “The Doctor’s Dilemma”. For the subject to be found throughout recorded history -- medical and nonmedical -- the issue must have been important, as it is today. Perhaps, some ideas to help us fix our current problems can be found in the past.

Additional Reference:
In the 1700s, physicians KNEW what their services and supplies cost. They had no excuse. But today, you ask a doc "what it costs" and they are completely clueless. Kinda hard to shaft the public if you TRULY don't KNOW what you are charging. That patient-doctor relationship has been usurped by a HUGE wad of scum-sucking middle men. Not the LEAST of which are the Armies of faceless, unaccountable Govt. bureaucrats.

Look "elsewhere" for 21st "medical inflation". Most of it just the inability of Govt to stay ahead of techniques and practices.
Red:
I expect that's so for doctors on staff in hospitals and who are answering that question with regard to what the hospital charges for their services. (Many doctors work at hospitals, but aren't employed by the hospital.) It's no different than the junior level consultants on my project teams who've never been part of the proposal or billing process. They know only what they get paid, not what the firm bills clients for their labors.

Doctors in private practice know exactly what their billing rates are. That too is similar to my own situation as a consultant. I know exactly what my standard ("rack") rate is, what my average bill rate across all my clients (thus my average realization rate), and what my specific rate is on any given engagement.
Not true that private practice doctors know much of ANYTHING about charges and costs. I know. I had my family under HSA plan for about 8 years. Since the 1st $6K was "self-funded" I'd shop around for docs who knew ANYTHING about costs and would discount for cash etc.. Very damn few can tell you.. Because EVERYONE gets a special deal nowadays. One price for MediCare, one price for Medicaid. Another price list for each separate insurer. The "RACK price" is just a fiction. Doctors NEVER get it. So no one should pay it or quote it or use it as propaganda. The only doctors who will regularly ALLOW staff to take a "wild ass stab" at costs are dermatologists..

My veterinarian makes more profit on a well visit or simple procedure than any of my doctors. After the govt and the insurance companies are done beating on them...
Well, you just keep on thinking that. I'm not going to devise reasons and explanations for why you managed to find the least business aware private practitioners in medical practice.

I can tell you, just as one example, that when your wife goes for her implants or face lift, the doctor will know exactly what it's going to cost her for him to do the procedures.
 

flacaltenn

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In the general prologue of The Canterbury Tales, Geoffrey Chaucer describes physicians as having a “special love for gold.” Since well before Chaucer’s time, the issue of physician remuneration has been discussed, with the debate continuing today. The earliest evidence of this issue is in the Code of Hammurabi from around 1750 BC. Hippocrates, Plato, and Galen discussed remuneration, and it was an issue in Jewish and Islamic culture too. During the last few centuries, issues around physician remuneration have continued to be discussed.

Probably the oldest extant primary source of medical fees is the code of Hammurabi. Written about 2000 B.C., the code is a set of laws decreed by King Hammurabi of Babylon. There are several references to physicians, including how they should be paid for their services. For example, sections 215-217 of the code read:
In medieval Europe, some physicians were employed by royalty and attended to the health of the royal court and perhaps some of its subjects, others were paid by the church to treat the sick of the parish and the poor. Some city states such as Venice employed physicians to give free treatment to the poor, treat the rich at reduced rates and advise the state on medical-legal and public health matters.

There are many sources from America which record how physicians were paid and whether fees were regulated or not. One example is the regulation of fees in Boston starting in 1780. It was the Boston Medical Society which developed the fee bill in order to stop physicians from undercutting each other. The fees on the fee bills were minimums so physicians could charge more, but no less. In addition, patients only wanted to pay for services if it included treatment such as a drug or a procedure. The fee bill however stipulated that charges be made for all visits. Because the physicians were controlling the fees, they made sure that they were always very well compensated, their general policy being to increase fees in good economic times but not to lower them in hard economic times. Between 1795 and 1806 the cost of living changed very little but the fees increased by 50-60%.

In Boston, we see an example where the physicians controlled their own remuneration and thus sometimes charged quite high amounts for their services. In South Carolina in 1844, we have an example of quite the opposite. The St. Peter’s parish, like the whole state, was very poor so the local officials decided to set a fee bill to curb the “exorbitant, oppressive” physician fees which “unjustly absorbs so large a portion of [the farmers] hard earned incomes.

If we compare the fees in Boston and South Carolina, we can see the vast difference in fees when physicians or the community set them. In Boston in 1806, a regular single visit was $1.50, normal obstetrical delivery was $12.00, treating gonorrhea was $10.00 and the fee for amputating a leg was set at $40.00. In South Carolina, almost three decades later in 1844, a regular single visit was no charge, normal obstetrical delivery was $3.00, treating gonorrhea was $2.00 and the fee for amputating a leg was set at $5.00.

The advancing settlement of America westward necessitated innovative solutions for physician remuneration due to low populations and poor patients. For example, a physician only agreed to move to Tucson, Arizona in 1871 after twenty-five families agreed to pay him $100 a year for his services. The frontier medical practice also required novel ways of payment such as poultry, cattle, tobacco, fruit, vegetables, wood and clothes. Barter was also a common payment method in Australia.

The very first physicians were military and naval surgeons and so would have been paid as salaried practitioners. As free settlers came though, “civilian” physicians would need to be paid and payment with goods and services would have been acceptable because the early Australian physician would have few places to spend his money. By the middle of the nineteenth century there are examples of fee regulation in Australia. The Port Philip Medical Association set fees for three different classes of patient with different fees for different classes. The 1st class patients (i.e. rich patients) had to pay two to five times as much as 3rd class (i.e. poor patients) for the same treatment.

From the very earliest of recorded history in the code of Hammurabi to the present day, we can find records of physician remuneration. It was an important matter of debate in medical texts as well as non-medical writings from Aristophanes’ and Sophocles’ plays as mentioned above to Moliere’s “Le Malade imaginare” and George Bernard Shaw’s “The Doctor’s Dilemma”. For the subject to be found throughout recorded history -- medical and nonmedical -- the issue must have been important, as it is today. Perhaps, some ideas to help us fix our current problems can be found in the past.

Additional Reference:
In the 1700s, physicians KNEW what their services and supplies cost. They had no excuse. But today, you ask a doc "what it costs" and they are completely clueless. Kinda hard to shaft the public if you TRULY don't KNOW what you are charging. That patient-doctor relationship has been usurped by a HUGE wad of scum-sucking middle men. Not the LEAST of which are the Armies of faceless, unaccountable Govt. bureaucrats.

Look "elsewhere" for 21st "medical inflation". Most of it just the inability of Govt to stay ahead of techniques and practices.
Red:
I expect that's so for doctors on staff in hospitals and who are answering that question with regard to what the hospital charges for their services. (Many doctors work at hospitals, but aren't employed by the hospital.) It's no different than the junior level consultants on my project teams who've never been part of the proposal or billing process. They know only what they get paid, not what the firm bills clients for their labors.

Doctors in private practice know exactly what their billing rates are. That too is similar to my own situation as a consultant. I know exactly what my standard ("rack") rate is, what my average bill rate across all my clients (thus my average realization rate), and what my specific rate is on any given engagement.
Not true that private practice doctors know much of ANYTHING about charges and costs. I know. I had my family under HSA plan for about 8 years. Since the 1st $6K was "self-funded" I'd shop around for docs who knew ANYTHING about costs and would discount for cash etc.. Very damn few can tell you.. Because EVERYONE gets a special deal nowadays. One price for MediCare, one price for Medicaid. Another price list for each separate insurer. The "RACK price" is just a fiction. Doctors NEVER get it. So no one should pay it or quote it or use it as propaganda. The only doctors who will regularly ALLOW staff to take a "wild ass stab" at costs are dermatologists..

My veterinarian makes more profit on a well visit or simple procedure than any of my doctors. After the govt and the insurance companies are done beating on them...
Well, you just keep on thinking that. I'm not going to devise reasons and explanations for why you managed to find the least business aware private practitioners in medical practice.

I can tell you, just as one example, that when your wife goes for her implants or face lift, the doctor will know exactly what it's going to cost her for him to do the procedures.
Yes. But that's a clue. Isn't it? The Plastic guys ARE often working directly with patients on the financials, because not very many folks have insurance for those things. They are sensitive to price competition. Often have to talk people out of going to Brazil or Thailand for a bargain.. Need to do accurate estimates all the time.. I'll bet the inflation for that specialty is well below most of the others.

Veterinarian services have NOT inflated anywhere NEAR human health care. And the vets themselves in private practice are much more secure in their income. That's another clue. And AGAIN -- having a market where CONSUMER directs the money and shop selection DOES matter in controlling pricing.

I once was in an engineering meeting for designing a new nebulizer. Couldn't figure out why nobody mentioned a "cost goal" for the product. The suits in the room starting laughing hysterically. Told me that this device would enable patients to treat at home -- save the "outpatient costs" and the trip to the hospital. But it would be YEARS until the Govt realized that savings were in there and would continue to reimburse at the same old rate. And if the GOVT reimbursed at the same rate -- the insurance companies would follow suit based on the medical coding of that procedure. So --- there's another clue that doesn't point to "doctor greed".
 

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