A special independent commission established by the American Medical Association recommended yesterday a series of extensive changes to bring the cost of medical care under control.
Although some of the recommendations are not new, many run against the grain of AMA policy positions and may stir further controversy within the medical profession.
The 27-member National Commission on the Cost of Medical Care was comprised of three past presidents of the AMA - including the commission chairman, Dr. Max H. Parrott - the presidents of the American Hospital Association, the Blue Cross Association, the Health Insurance Association of America, officials from leading medical institutions and from state and federal government.
AMA executive vice president James H. Sammons emphasized that "the commission has been and is an entity unto itself. The report at this point is just that - the report of the commission. It is controversial: parts of it run contrary to present AMA policy. I expect - and I hope - it will generate constructive debate throughout the profession to arrive at solutions to unprecedented problems."
Parrott, looking ahead to the annual meeting in St. Louis next June, when the report will be presented for adoption by the AMA House of Delegates, said, "We're going to have trouble with this with the House."
The recommendations include changing federal tax policy to increase consumer awareness of the cost of medical care, now 8.6 per cent of the gross national product: encouraging competition among forms of health care delivery; publishing prices charged by physicians for commonly performed procedures; promoting voluntary cost control measures in the hospital industry, and finding ways to put physicians "at risk" for the cost of inappropriate care given patients.
The commission specifically recommended against increasing the supply of medical school graduates "unitl such time as necessity for change is clearly evident," and against an administration sponsored proposal now before Congress to limit by legislation the amount of capital expenditures that can be made to expand hospitals and purchase equipment.
The panels first recommendation is to alter present economic incentives in the purchase of insurance and health plans by changing present tax policies, which encourage employers to reward employees with health benefits rather than wages.
"The current exclusion from taxable income of employer-paid health insurance premiums and the current tax deduction for consumer payments for insurance premiums should be replaced with either a fixed dollar tax credit or deduction," the report says.
It also recommends that consumers be made aware of the cost of medical care by having patients pay some portion of both the care and the insurance premiums.
Health maintenance organizations, a form of pre-paid medical care in which doctors are paid either a salary or by the patient, have been criticized in the past by the AMA: they are favorably mentioned in the report. "Those who have contracted to deliver services are at risk: consequently they have an incentive to deliver only necessay services." the report said. "Unfortunately, public policy has not been neutral between HMOs and fee-for service practice."
The report also recommends that local certificate-of-need laws - requirements for central approval of capital expansion by hospitals and other institutions - be expanded to include private physicians' offices, with coverage to begin at expenditute of $150,000. The AMA has lobbied with Congress in the past to exclude physicians' offices from certificate-of-need laws.