Physician Payment Policies: Impacts and Implications

Rice, Thomas

doi:10.1146/annurev.publhealth.18.1.549

Cited by 19 publications

(7 citation statements)

References 18 publications

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“…In general, effectiveness can be described by the capability of the selected procedure to achieve the objective -in our case the recovery of the patient. The "fee for service" system meets these requirements (Rice 1997;Devlin and Sarma 2008). Physicians who provide a sizable clientele with a maximum of services are rewarded, sanctioning those who accomplish less quantity (Robinson 2001).…”

Section: Discussionmentioning

confidence: 99%

Behaviour in therapeutic medical care: evidence from general practitioners in Austria

2010

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Aim The present study examines monetary effects of general practioners' behaviour in therapeutic medical care to identify sample characteristics that allow differentiating between the individual general practitioner and the basic population. Subjects and methods Medical services, provided by 3919 general practitioners in Austria, were operationalized by means of the dependent variable "costs per patient". Statistical outliers were identified using Chebyshev's inequality and categorized by investigating bivariate correlations between the dependent variable and the personal characteristics of each physician. Results Variables that relate to the size of the customer base, such as number of consultations (r = 0.385) and office days (r = 0.376), correlate positively with the costs for medical services. By analyzing the portfolio of the general practitioners, we found a correlation of 0.451 between this coefficient and the costs. Statistical outliers feature an average portfolio of 44.5 different services, compared to 30.45 among non-outliers. Especially laboratory services were identified as cost drivers (r = 0.408). Statistical outliers generate at least one laboratory parameter for 44.34% of their patients, opposed to 27.2 % within the rest of the sample. Consequently outliers produce higher laboratory costs than their counterparts. Conclusion We found some evidence that physicians have influence in the provision of their services. Considering entrepreneurial objectives the extension of the portfolio can increase their profit. Our findings indicate supplier-induced demand for several groups of services. We assume that the effect is consolidated by the fee for service system and could be compensated by adequate reform.Response to Reviewers: I uploaded a sideletter to the reviewer including the list of changes. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 ConclusionWe found some evidence that physicians have influence in the provision of their services. Considering entrepreneurial objectives the extension of the portfolio can increase their profit. Our findings indicate supplier-induced demand for several groups of services. We assume that the effect is consolidated by the fee for service system and could be compensated by adequate reform.

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Section: Discussionmentioning

confidence: 99%

Behaviour in therapeutic medical care: evidence from general practitioners in Austria

2010

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“…County, normal health status, department, disease, LOS and the degree to which doctors believe they can understand the patient’s feelings significantly affect the appropriateness of the children’s hospitalisation in county hospitals in rural China (Table 5). International experience shows that the mode of medical insurance payment determines the mode of operation of medical providers, thereby affecting the inappropriate admissions [28–30]. Therefore, the differences of NRCMS payment methods in the investigated areas led to the discrepancies among county hospitals.…”

Section: Discussionmentioning

confidence: 99%

Determinants of inappropriate admissions of children to county hospitals: a cross-sectional study from rural China

Lei

Zhang

et al. 2019

BMC Health Serv Res

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Background The incidence of inappropriate admissions in China has become the shackle of its’ service supply system. This research aims to assess the level of children’s inappropriate admissions to county hospitals in rural China and identify the characteristics and determinants of children’s inappropriate admissions. Methods A retrospective review was conducted on data of children aged 0–14 years. A total of 771 children medical records in four county hospitals was collected by stratified random sampling in Midwestern China and was evaluated through the Rural Appropriateness Evaluation Protocol. A questionnaire survey was conducted among doctors whose names were shown in medical records. Chi-square test was used to analyse the characteristics of inappropriate admissions, and a binary logistic regression model was used to examine the determinants of inappropriate admissions. Results Inappropriate admissions indicate that patients who could have been treated as outpatients received services as inpatients. The average rate for inappropriate admissions of children in county hospitals was 61.35%. The highest rate of inappropriate admissions was found among children aged 1–5 years (68.42%). Inappropriate admissions mostly occurred in children with respiratory diseases (72.45%), circulatory diseases (72.22%) and certain infectious diseases and parasitic diseases (70.37%). Binary logistic regression analysis showed that county, normal health status, treating department, disease, the length of hospital stay and the doctor’s self-evaluation on the understanding about the degree of the patient’s feelings were determinants for children’s inappropriate admissions. Conclusions County hospitals have a high rate of inappropriate admissions of children. The relationship of children’s inappropriate admissions to age distribution and the insurance compensation is affected by disease and hospitalisation expenses, respectively. The determinants of children’s inappropriate admissions are directly related to the weak level of primary care services in the health service system, the initial requirements requested by children’s admission decision makers and the interests among medical institutions and doctors. Electronic supplementary material The online version of this article (10.1186/s12913-019-3944-1) contains supplementary material, which is available to authorized users.

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“…There have been no longitudinal studies that distinguish the impact of organization-level and physician-level incentives on either the utilization or quality of health services. Rice (1997) has called for such research, suggesting that researchers take advantage of natural experiments of variation in incentives across different markets. Variation in incentives over time and across markets would provide an even better set of test conditions for assessing the causal effects of incentives on quality.…”

Section: Additional Studies Of Physician Financial Incentivesmentioning

confidence: 99%

Penetrating the “Black Box”: Financial Incentives for Enhancing the Quality of Physician Services

Conrad

Christianson

2004

Med Care Res Rev

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This article addresses the impact of financial incentives on physician behavior, focusing on quality of care. Changing market conditions, evolving social forces, and continuing organizational evolution in health services have raised societal awareness and expectations concerning quality. This article proceeds in four parts. First, the authors place financial incentives in the context of broader forces shaping the quality of physician services. Second, the article reviews the literature on financial incentive effects on physician behavior. Third, a simple net income maximization model of physician choices is presented, from which are derived formal hypotheses regarding the effect of financial incentives on physician choices of quality per unit of physician service and the quantity of services per patient. The model is extended qualitatively to offer further hypotheses and research directions. Finally, gaps and limitations of the model and of the extant empirical research are articulated, and additional researchable questions are posed.

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Physician Payment Policies: Impacts and Implications

Cited by 19 publications

References 18 publications

Behaviour in therapeutic medical care: evidence from general practitioners in Austria

Behaviour in therapeutic medical care: evidence from general practitioners in Austria

Determinants of inappropriate admissions of children to county hospitals: a cross-sectional study from rural China

Penetrating the “Black Box”: Financial Incentives for Enhancing the Quality of Physician Services

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