By NextBestFitPhase 1: Enactment & build · Step 1.7
Set the national fee schedule
Months 3–15; annual updates thereafter · Payment Rates Board; UHADiscuss this step
How other countries handled this same piece of implementation, what happened, and what it means for this plan.
Side by side
| Country | Approach | Result | Lesson for this plan |
|---|---|---|---|
| This plan (U.S.) | Adopt Medicare's RBRVS fee schedule as the base, raise primary care to 125% of Medicare, procedural specialties to 105%, and others to 112% on average. Physician & clinical UHP spending becomes $1.05T (price effect −$21.4B, utilization effect +$113.0B). | ||
| Japan | One national fee schedule for every payer, revised every 2 years by the Central Social Insurance Medical Council. | Strict price control and very high volume; spending about 11% of GDP despite the oldest population. | One price list is the most powerful cost-control tool, more than the number of payers. |
| Germany | Collective negotiation of the EBM fee schedule between physician associations and sickness funds; regional budgets with point values. | Short waits; private patients pay higher GOÄ fees and get priority. | Uniform public fees with a higher private schedule recreates two tiers. |
| Canada | Provincial fee schedules negotiated with medical associations. | Physician incomes comparable to U.S. primary care; specialists earn less than U.S. peers. | Negotiated schedules compress specialist-to-primary-care income ratios. |
Japan
- What they did
- One national fee schedule for every payer, revised every 2 years by the Central Social Insurance Medical Council.
- What happened
- Strict price control and very high volume; spending about 11% of GDP despite the oldest population.
- Lesson for this plan
- One price list is the most powerful cost-control tool, more than the number of payers.
Germany
- What they did
- Collective negotiation of the EBM fee schedule between physician associations and sickness funds; regional budgets with point values.
- What happened
- Short waits; private patients pay higher GOÄ fees and get priority.
- Lesson for this plan
- Uniform public fees with a higher private schedule recreates two tiers.
Canada
- What they did
- Provincial fee schedules negotiated with medical associations.
- What happened
- Physician incomes comparable to U.S. primary care; specialists earn less than U.S. peers.
- Lesson for this plan
- Negotiated schedules compress specialist-to-primary-care income ratios.
More precedent
- Japan sets a single national fee schedule every two years for all payers, and has kept spending growth low for decades.
- Germany's EBM and Canada's provincial schedules are negotiated with physician associations.