Impact of payment method on behaviour of primary care physicians: a systematic review

Gosden, Toby; Forland, Frode; Kristiansen, Ivar Sønbø; Sutton, Matt; Leese, Brenda; Giuffrida, Antonio; Sergison, Michelle; Pedersen, Lone Lund

doi:10.1258/1355819011927198

Cited by 237 publications

(201 citation statements)

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“…3,61 FFS encourages and capitation discourages resource consumption. The dominant fee-for-service approach as implemented in the US over the past 2 decades has contributed to both the continuing decline in the primary care workforce and the diminished capability to serve patients well.…”

Section: Resultsmentioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

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The purpose of this paper is to address why the three dominant alternatives to compensating physicians (feefor-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. 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. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.KEY WORDS: primary care; reimbursement; health care delivery.

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Section: Resultsmentioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

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“…For this study we selected five of these. [26][27][28][29][30] We extracted data, assessed review quality using a checklist and assessed evidence quality using GRADE. 31,32 Based on earlier…”

Section: Selecting Reviews and Developing Contentmentioning

confidence: 99%

Evidence summaries tailored to health policy-makers in low- and middle-income countries

Rosenbaum

Glenton

Wiysonge

et al. 2010

Bull. World Health Organ.

156

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“…However, most primary health care services are not provided by PHOs, but by traditional GP-owned and GP-managed practices. At the general practice level, it is known that different payment systems have different effects on practice patterns (Gosden et al, 2001). It is now widely understood that blended payment systems may be the best way to offset the intrinsic limitations of fee-for-service, salary and capitation (Robinson, 2001).…”

Section: Paying Providersmentioning

confidence: 99%

New Zealand’s Primary Health Care Strategy: early effects of the new financing and payment system for general practice and future challenges

Cumming

Mays

2009

HEPL

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: Since 2001, implementation of a New Zealand's Primary Health CareStrategy (the Strategy) has led to an increase in the proportion of primary health care services which are publicly funded, the development of 82 primary health organisations (PHOs) to oversee primary health care services and universal public capitation funding of PHOs. This approach has replaced the previous system of fee-for service targeted public subsidies paid to individual general practitioners (GPs). Patient copayments, although at a reduced level but still set by individual practitioners, have remained a core feature of the system. This paper focuses on the implementation and impact of key policy changes over the first five years of the Strategy. Although patient copayments have fallen and consultation rates have increased, the new funding and payment system has raised a number of unresolved issues -whether to retain the new universal funding system or revert to the former targeted approach; how to achieve the potential gains from capitation when GPs continue to receive their income from a variety of sources and in a variety of different ways; and how to manage the potential for 'cream skimming'.Recent improvements in access may, in time, improve health status and reduce inequalities in health, but there is no guarantee that a universal system will necessarily improve average health or reduce inequalities. Much depends on the services being delivered and the populations that are benefiting mostsomething New Zealand needs better evidence on before determining future policy directions in primary health care.

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Impact of payment method on behaviour of primary care physicians: a systematic review

Cited by 237 publications

References 0 publications

US Approaches to Physician Payment: The Deconstruction of Primary Care

US Approaches to Physician Payment: The Deconstruction of Primary Care

Evidence summaries tailored to health policy-makers in low- and middle-income countries

New Zealand’s Primary Health Care Strategy: early effects of the new financing and payment system for general practice and future challenges

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