Remuneration of medical specialists. Drivers of the differences between six European countries

Kok, Lucy; Boyle, Seán; Lammers, Marloes; Tempelman, C.

doi:10.1016/j.healthpol.2015.04.003

Cited by 8 publications

(4 citation statements)

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“…[ 77 ] This may be the reason why family practitioners have the highest income in the Netherlands and England. [ 78 ] Therefore, one can say that in countries such as the US and Iran where there is a large income gap between family physicians and specialist, the likelihood of conflict of interest and the resulting problems will be exacerbated by implementing the family physician program with the gatekeeper role and the compulsory referral system. [ 14 79 ] In countries such as the United Kingdom, conflict of interest has been managed in different ways such as reforming the payment system and launching of a transparent information system[ 28 ]…”

Section: Discussionmentioning

confidence: 99%

Family physician model in the health system of selected countries: A comparative study summary

Mohammadibakhsh

Aryankhesal

Jafari

et al. 2020

J Edu Health Promot

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BACKGROUND: In the 21 st century, with the epidemiological and demographic transition and the changing nature of diseases and the increase in the burden of chronic diseases, the need to strengthen primary health care and the development of the family medical program as a strategy is felt significantly. AIM: The purpose of this study is to compare the model of implementation of family physician program (FPP) in the United States, England, Germany, Singapore, Turkey, Egypt, and Iran. MATERIALS AND METHODS: This is a comparative study that examines the model of family physician implementation in selected countries. Data for each country were gathered from the valid databases, were compared according to the comparative table, and analyzed by a framework approach. In order to assure the validity of data, the researchers referred to the websites of the selected nations' Ministry of Health and also cross-checked the findings with reports published by the World Health Organization. RESULTS: In this study, we used the Control Knobs framework to compare countries' FPPs because the framework can demonstrate all necessary features of national health system programs. This framework includes governance and organization, regulation, financing, payment, and behavior in each country. The results of this study show that although the principles of FPP in the selected countries are almost common, they use different methods in FPP implementation. CONCLUSIONS: As the success of any policy depends on the political, economic, social, and cultural context of each country, considering these factors and reinforcing each of the control knobs are critical to the success of the family physician's policy implementation.

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Section: Discussionmentioning

confidence: 99%

Family physician model in the health system of selected countries: A comparative study summary

Mohammadibakhsh

Aryankhesal

Jafari

et al. 2020

J Edu Health Promot

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“…During several decades of fee regulation by the Dutch government, supplementary fees gradually converged to 0, without seriously reducing the income of medical specialists. In 2012, Dutch medical specialists earned more than their colleagues in neighbouring countries, such as Belgium, Denmark and Germany (Kok et al ., 2015).…”

Section: Measures To Curb Cost Inflationmentioning

confidence: 99%

Supplementary physicians’ fees: a sustainable system?

Calcoen

Ven

2018

HEPL

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In Belgium and France, physicians can charge a supplementary fee on top of the tariff set by the mandatory basic health insurance scheme. In both countries, the supplementary fee system is under pressure because of financial sustainability concerns and a lack of added value for the patient. Expenditure on supplementary fees is increasing much faster than total health expenditure. So far, measures taken to curb this trend have not been successful. For certain categories of physicians, supplementary fees represent one-third of total income. For patients, however, the added value of supplementary fees is not that clear. Supplementary fees can buy comfort and access to physicians who refuse to treat patients who are not willing to pay supplementary fees. Perceived quality of care plays an important role in patients' willingness to pay supplementary fees. Today, there is no evidence that physicians who charge supplementary fees provide better quality of care than physicians who do not. However, linking supplementary fees to objectively proven quality of care and limiting access to top quality care to patients able and willing to pay supplementary fees might not be socially acceptable in many countries. Our conclusion is that supplementary physicians' fees are not sustainable.

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“…(e.g. in the Netherlands about half of hospital physicians are paid using FFS, while the other half is paid a fixed salary [21]). Or it may be the case that the hospital receives a global budget from the payer, while the physicians are paid FFS (as was the case in the Netherlands after 1983 [12]).…”

Section: Mixed Payment Schemesmentioning

confidence: 99%

“…We assumed that the counterfactual distribution of total treatment times without the disturbances caused by manipulation would have been monotone decreasing and convex. 21 We modeled this trend by adding the quadratic term t2 to our regression.…”

Section: Analysis I -Evidence Of Manipulationmentioning

confidence: 99%

Towards More Appropriate Care

Gaspar¹

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SUMMARY It is often argued that health care providers (e.g. hospitals, physicians, etc.) are imperfect agents of the patient: over-supplying (or in certain situations under-supplying) health care services when facing a financial advantage to do so.[1] Hence, changing the incentives in provider payment contracts may lead to more appropriate provision of health care. This belief was the motivation for the design of several innovative reimbursement arrangements, such as Medicare’s Hospital Readmission Reduction Program or Maryland’s All-Payer program, created under Affordable Care Act (ACA), and the creation of Accountable Care Organizations.[2] However, the results of these initiatives have been mixed, leading experts to conclude that reaching optimal contract design is more tedious than originally believed.[3] Therefore, it is important to understand what drives providers and under what conditions they respond to financial incentives. Although health care providers’ response to financial stimulus has been empirically shown in an abundance of cases [1, 4], its magnitude is far from uniform and, in certain cases, researchers found no measurable response at all ([5-8]). There is a shortage of comprehensive analyses on exactly what drives providers’ behavior, which hampers the realization of optimal payment designs. In the present dissertation, I attempt to illustrate how providers respond to incentives in various environments and provide recommendations on the optimal payment design in order to obtain high quality and affordable care. My research utilizes examples of policy-reforms and payment design discontinuities in Dutch health care as ‘natural experiments’ that allow me to quantify responses to sudden shifts in the incentive structure. My work focuses primarily on medical specialist care (secondary care) and utilizes claim-level administrative data from Dutch health insurers for the years 2006 to 2018. Overall, my results show that providers with guaranteed budgets, that were independent of production volumes, achieved higher productivity growths and lower growths in treatment intensity, than those with volume-driven arrangements, demonstrating that providers were able to improve efficiency when incentivized to do so using guaranteed budgets (in Chapters 2-3). However, when going deeper and evaluating health care organizations’ response to financial incentives using discontinuities in reimbursement schedules (in Chapters 4-5) I found that the response was not uniform among all providers: small, profit-oriented organizations, especially those in financial distress, were more likely to maximize revenues by strategically discharging patients when a higher tariff was reached. In addition, I demonstrate that the same organization (i.e. rehabilitation centers) showed no response to the discontinuity in an outpatient setting, while strong response is observed in an inpatient setting. A possible interpretation could be the higher potential financial gains from utilizing strategic discharge behavior. Overall, these findings imply that moving away from volume-based production arrangement towards guaranteed payments (e.g. global budgets) could present the right incentives for containing costs and improving efficiency. Global budget mechanisms, however, are not new. These arrangements have been frequently used since the first wave of health care reforms after World War II. [9]. Lessons learnt from these, as well as more recent experiments, such as Maryland’s All-Payer program and pilot programs such as Bernhoven Hospital in the Netherlands, must be considered when designing hospital contracts. Most importantly, the mechanism should appropriately reward gains in market share in order to continue to encourage competition between providers and to circumvent the build-up of waiting lists, while quality and continuity of care must be guaranteed, and policy-makers should ensure that the mechanism is in line with other reimbursement arrangements (e.g. DRG- systems, risk-adjustment mechanisms).

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Remuneration of medical specialists. Drivers of the differences between six European countries

Cited by 8 publications

References 8 publications

Family physician model in the health system of selected countries: A comparative study summary

Family physician model in the health system of selected countries: A comparative study summary

Supplementary physicians’ fees: a sustainable system?

Towards More Appropriate Care

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