Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians

Gosden, Toby; Forland, Frode; Is, Kristiansen; Sutton, Matthew; Leese, Brenda; Giuffrida, Antonio; Sergison, Michelle; Pedersen, Lone Lund

doi:10.1002/14651858.cd002215

Cited by 285 publications

(273 citation statements)

References 26 publications

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“…A review examined studies from high-income countries and reported that a fee-for-service approach resulted in greater compliance with recommended well-child visits than did capitation payments. 58 Additionally, moderate-quality evidence shows that defaulter tracking-reminder and recall strategies in particular-eff ectively increases routine childhood immuni sation rates in high-income countries. 59,60 Improving quality of care…”

Section: Improving Continuity Of Carementioning

confidence: 99%

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

et al. 2012

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Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the eff ective coverage of essential interventions. First, we identify four diff erent intervention delivery channels-ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to eff ective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of eff ective interventionsand, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of fi nancial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources.

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Section: Improving Continuity Of Carementioning

confidence: 99%

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

et al. 2012

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“…Seminal articles have presented theoretical models of GP behaviour (Ellis & McGuire, 1986;Harsanyi, 1955;McCombs, 1984;McGuire, 2000;Thornton & Eakin, 1997) and a substantial amount of empirical research has been conducted on the impact of organizational characteristics on delivery of GP services, focusing mostly on remuneration systems (Ellis & McGuire, 1990;Gosden et al, 2000;Laffont & Tirole, 1993) and the GP gate keeper role (Brekke et al, 2007;Dusheiko et al, 2006). However, much less is known about doctors' behaviour in publicly-oriented systems which have a high degree of focus on costcontainment and guidelines.…”

Section: Introductionmentioning

confidence: 99%

GPs' implicit prioritization through clinical choices – evidence from three national health services

Riise

Hole

Gyrd‐Hansen

et al. 2016

Journal of Health Economics

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We present results from an extensive discrete choice experiment, which was conducted in three countries (Norway, Scotland, and England) with the aim of disclosing stated prescription behaviour in different decision making contexts and across different cost containment cultures. We show that GPs in all countries respond to information about societal costs, benefits and effectiveness, and that they make trade-offs between them. The UK GPs have higher willingness to accept costs when they can prescribe medicines that are cheaper or more preferred by the patient, while Norwegian GPs tend to have higher willingness to accept costs for attributes regarding effectiveness or the doctors' experience. In general there is a substantial amount of heterogeneity also within each country. We discuss the results from the DCE in the light of the GPs' two conflicting agency roles and what we know about the incentive structures and cultures in the different countries.2

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“…Under this interpretation, the coefficient on effort should be the value placed on cure by the patient. 18 This • Both v rich and v poor are indifferent between the two doctors. This follows since they are kept at their reservation utility by both doctors; all differences in the quality provided are fully captured by changes in the price charged.…”

Section: Simple Behavioral Models With Alternative Market Closure Rulesmentioning

confidence: 96%

Money for Nothing: The Dire Straits of Medical Practice in Delhi, India

Das

Hammer

2005

SSRN Journal

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The quality of medical care received by patients varies for two reasons: Differences in doctors' competence or differences in doctors' incentives. Using medical vignettes, we evaluated competence for a sample of doctors in Delhi. One month later, we observed the same doctors in their practice. We find three patterns in the data. First, what doctors do is less than what they know they should do-doctors operate well inside their knowledge frontier. Second, competence and effort are complementary so that doctors who know more also do more. Third, the gap between what doctors do and what they know responds to incentives: Doctors in the fee-for-service private sector are closer in practice to their knowledge frontier than those in the fixed-salary public sector. Under-qualified private sector doctors, even though they know less, provide better care on average than their better-qualified counterparts in the public sector. These results indicate that to improve medical services, at least for poor people, there should be greater emphasis on changing the incentives of public providers rather than increasing provider competence through training.

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Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians

Abstract: Indicates the major publication for the study 11 Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians (Review)

Cited by 285 publications

References 26 publications

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

GPs' implicit prioritization through clinical choices – evidence from three national health services

Money for Nothing: The Dire Straits of Medical Practice in Delhi, India

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