Physician payment schemes and physician productivity: Analysis of Turkish healthcare reforms

Erus, Burcay; Hatipoglu, Ozan

doi:10.1016/j.healthpol.2017.02.012

Cited by 20 publications

(12 citation statements)

References 20 publications

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“…In developed countries, such as the UK and the USA, the income of specialists is usually to 3 to 4 times of the national average income22; therefore, the income found in our study was relatively low. Physicians, like everyone, are interested in their income 23–25. Hence, the mechanism through which physicians are paid and how much they are paid can affect intention to resign.…”

Section: Discussionmentioning

confidence: 99%

Factors determining intention to leave among physicians in tertiary hospitals in China: a national cross-sectional study

Zhang

et al. 2019

BMJ Open

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ObjectiveThe reasons that physicians leave the institutions have not been extensively studied. We aimed to evaluate these reasons, which include the desire to work at another hospital or the intention to make a career change, among physicians in tertiary hospitals in China and explore the associations between the individual-level and organizational-level factors related to these two reasons for leaving.MethodsWe conducted a national survey of 136 tertiary hospitals across all 31 provinces in China between December 2017 and January 2018. A total of 20 785 physicians were selected to self-report on the two evaluated reasons related to physicians’ intent to leave. A univariate analysis and multilevel regression model were applied to evaluate the factors associated with intention to leave.ResultIn all, 10.4% of the participating physicians had thought about working at another hospital, and 20.5% intended to leave to make a career change. At the hospital level, the government subsidy per bed (OR=0.88, 95% CI: 0.86 to 0.98 and OR=0.91, 95% CI: 0.90 to 0.99), personnel funding per capita (OR=0.86, 95% CI: 0.76 to 0.96 and OR=0.80, 95% CI: 0.73 to 0.88) and the number of physicians per bed (OR=0.83, 95% CI: 0.81 to 0.86 and OR=0.89, 95% CI: 0.81 to 0.92) were negatively associated, while the number of hospital-level medical disputes (OR=1.04, 95% CI: 1.03 to 1.05 and OR=1.06, 95% CI: 1.01 to 1.11) was positively associated with both reasons for leaving. At the individual level, income (OR=0.74, 95% CI: 0.71 to 0.79 and OR=0.88, 95% CI:0.83 to 0.92) and job satisfaction (OR=0.18, 95% CI: 0.17 to 0.20 and OR=0.16, 95% CI: 0.15 to 0.18) acted as preventive factors against both reasons for leaving, while work hours per week (OR=1.11, 95% CI: 1.06 to 1.17 and OR=1.23, 95% CI: 1.19 to 1.28) and medical dispute (OR=1.49, 95% CI:1.35 to 1.65 and OR=1.77, 95% CI: 1.64 to 1.91) acted as promotive factors.ConclusionsAlthough the intention to leave is not prevalent among physicians in tertiary hospitals in China, providing more organisational support and a better occupational environment may promote retention among physicians.

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Section: Discussionmentioning

confidence: 99%

Factors determining intention to leave among physicians in tertiary hospitals in China: a national cross-sectional study

Zhang

et al. 2019

BMJ Open

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“…25 Performance-based financing gives positive motivation for the quality of care improvement 26 and physician productivity through full-time practice. 27 It was viewed that pay-for-performance and financial incentives can improve health access and quality of service. 25,[28][29][30] However, financial incentives may lead to overutilization through overdiagnosis and overtreatment 25,31 to avoid litigation or to increase income.…”

Section: Conduct Of the Policy Roundtable Discussionmentioning

confidence: 99%

Rationalizing Health Personnel Financing Schemes for Evidence-informed Policy Reforms: Policy Analysis

Lam¹,

Rey²,

Zarsuelo³

et al. 2020

Acta Med Philipp

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Background. The Universal Health Care Law seeks to optimize financing of personnel costs without compromising quality and equitable health care among the health care facilities. This position statement aimed to identify strategies and policy recommendations for the cost-effective financing of health personnel in public healthcare facilities. Methods. A systematic review of literature was done to generate policy brief and key points for roundtable discussion in collaboration with the Department of Health (DOH). The discussion was guided by the three health financing options of DOH: (a) retain Personnel Services (PS) as DOH budget but shift Maintenance and Other Operating Expenses (MOOE) to PhilHealth; (b) shift PS and MOOE to PhilHealth, and (c) rationalize part-time status in government hospitals. Results. The pros and cons of financing options were cross-examined. In Option 1, physicians in government hospitals would receive fixed salaries from DOH / Local Government Units. In Option 2, there would be a monopsony between PhilHealth and provincial power. Payment will be performance-driven, and balance billing will be eliminated. Option 3 would be a set up of retaining part-time positions for physicians. Conclusion and Recommendation. Participants deduced that for Option 1, provision of salary augmentation sources and ensuring adequate plantilla items and level of remuneration in government hospitals should be considered, in order to sufficiently compete with physicians’ income from private practice. For Option 2, the PhilHealth reimbursement system should ensure timely reimbursement so as not to subject care providers to financial instabilities. For Option 3, rationalizing part-time status should be flexible and can be applied regardless of how physicians are paid, as this would incentivize caregivers to work harder and smarter.

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“…Multiple policy reforms have been launched in cancer care, but provider payment models remain an area of contention among policy makers. Shifting the orientation of the provider reimbursement system from services to outcomes requires the identification and reward of high-quality, patient-centered care [5][6][7][8][9]. This transition is tied to care coordination and service delivery models to establish the components of a value-based system.…”

Section: Introductionmentioning

confidence: 99%

The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review

et al. 2019

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Objectives To investigate the impact of provider payment reforms and associated care delivery models on cost and quality in cancer care. Methods Data sources/study setting: Review of English-language literature published in PubMed, Embase and Cochrane library (2007-2019). Study design: We performed a systematic literature review (SLR) to identify the impact of cancer care reforms. Primary endpoints were resource use, cost, quality of care, and clinical outcomes. Data collection/extraction methods: For each study, we extracted and categorized comparative data on the impact of policy reforms. Given the heterogeneity in patients, interventions and outcome measures, we did a qualitative synthesis rather than a metaanalysis. Results Of the 26 included studies, seven evaluations were in fact qualified as quasi experimental designs in retrospect. Alternative payment models were significantly associated with reduction in resource use and cost in cancer care. Across the seventeen studies reporting data on the implicit payment reforms through care coordination, the adoption of clinical pathways was found effective in reduction of unnecessary use of low value services and associated costs. The estimates of all measures in ACO models varied considerably across participating providers, and our review found a rather mixed impact on cancer care outcomes.

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Physician payment schemes and physician productivity: Analysis of Turkish healthcare reforms

Cited by 20 publications

References 20 publications

Factors determining intention to leave among physicians in tertiary hospitals in China: a national cross-sectional study

Factors determining intention to leave among physicians in tertiary hospitals in China: a national cross-sectional study

Rationalizing Health Personnel Financing Schemes for Evidence-informed Policy Reforms: Policy Analysis

The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review

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