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U.S. Approaches to Physician Payment: The Deconstruction of Primary Care

"Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well," write the authors of this article in a special supplement to the Journal of General Internal Medicine. At the same time, the alternatives, including bundled payment, capitation, and salaried physicians, "each have their own problems," they say. The authors explore the history of primary care physician reimbursement and the current system within that context, and illustrate why physician payment mechanisms are "inadequate for even basic primary care services, let alone the fully implemented medical home." They argue that new, hybrid payment models combining the best features of the standard approaches "will likely be required to restore primary care to its proper role in the U.S. health care system and to promote and sustain the development of patient-centered medical homes."

This research was supported by The Commonwealth Fund, the Agency for Healthcare Research and Quality, and the American Board of Internal Medicine Foundation.

Publication Details



R. A. Berenson and E. C. Rich, "U.S. Approaches to Physician Payment: The Deconstruction of Primary Care," Journal of General Internal Medicine, June 2010 25(6):613–18.