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These various strictures imposed on doctors and their patients worked for about half a decade.
But some of the high cost imposed on doctors and hospitals may benefit insurers, since they lead to delayed payments and denial of claims.
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Another reason might be that the increased work load imposed on doctors in Germany – with increased nonmedical documentation tasks and the drastically increased clinical work caused by cost-cutting reforms such as the introduction of the Diagnosis Related Group – might slow down the implementation of published guidelines due to shortcomings in medical continuing education [ 7].
Thus, investing in costly and complicated information systems imposes expenses on doctors and hospitals that they cannot recoup through the normal forces of competition.
Finally, a decade after the death of Pack's children and following years of campaigning, the state legislature imposed a levy on on doctors' and pharmacists' license fees to upgrade the system.
While these barriers can reduce waste by preventing unnecessary care, they can also discourage patients from receiving care they need, as well as impose administrative burdens on doctors and patients.
The idea was simple: Herd patients into health maintenance organizations or large physician networks; impose "best practices" on doctors and patients to encourage preventive medicine and eliminate wasteful spending; and cut costs through administrative economies.
These groups have instead pursued more incremental measures, like waiting periods, requiring sonograms, and imposing stricter regulations on doctors and clinics and, in 10 states so far, bans on abortion at 20 weeks, an approach that is nearer to the viability threshold, but is under challenge in the courts.
The Supreme Court is engaged in a fierce debate over whether state laws that impose strict regulations on doctors and abortion clinics put an unconstitutional burden on women seeking to end pregnancies.
The result might rather suggest that policy makers are adequately protecting patients' interests by "imposing" high effort on doctors and monitoring their actions.
The health secretary, Jeremy Hunt, announced on Thursday that the contract would be imposed on junior doctors after a deadline to accept a "best and final" offer passed on Wednesday night passed without agreement.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com