Pediatrics and economics

WHETHER we like it or not, we must admit that we are living and working in a period of basic changes in the economic aspects of the practice of medicine. There was a day when the physician could make his visits on a completely individual basis and charge as much for his services as he considered appropriate. His bills were entirely between himself and his patients. But today an increasing number of physicians are finding themselves participants in one or another of the many medical care plans which are spreading rapidly throughout the country. A great variety of plans are being developed by public welfare agencies, health departments, non-profit organizations, medical societies, unions, cooperatives and other groups. Under the provisions of these plans the physician must abide by certain regulations directly affecting his practice and the fees he is entitled to collect. The growth of the Blue Shield plans for voluntary medical care insurance has been phenomenal and is now so rapid that it is impossible to state accurately from day to day the number of their subscribers. A recent estimate indicates that there are 48 plans with more than 7,000,000 subscribers. In fact Blue Shield seems to be on the way to catching up with Blue Cross, which now has some 30,000,000 subscribers. Other plans are testing different methods of providing service. One of the most notable of these is the Maryland Medical Care Program, which was established by legislation in 1945 providing that the State Department of Health should administer a program of medical services for indigent and medically indigent persons. Under the provisions of this plan county health officers have assumed administrative responsibility for this program of medical services; physicians are paid directly by the State Treasurer in accordance with a fixed fee schedule.