Factors that influence specialist physician preferences for fee-for-service and salary-based payment models: A qualitative study

Ogundeji, Yewande Kofoworola; Quinn, Amity E.; Lunney, Meaghan; Chong, Christy; Chew, Derek S.; Danso, George K.; Duggan, Shelly; Edwards, Alun; Hopkin, Gareth; Senior, Peter; Sumner, Glen; Williams, Jennifer J.; Manns, Braden

doi:10.1016/j.healthpol.2020.12.014

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…This multi-institutional qualitative study explored academic surgeon perspectives on the association between financial incentives and clinical practice. Surgeons reported that compensation models with clinical productivity–based incentives may increase engagement in revenue-generating clinical activities but had several disadvantages, including concerns over internal competition, burnout, and incentivizing operative management, suggestive of supplier-induced demand . Conversely, salaried surgeons described collaboration with colleagues and engagement in activities outside of direct patient care, such as research and education.…”

Section: Discussionmentioning

confidence: 99%

Perceived Implications of Compensation Structure for Academic Surgical Practice

Finn,

Syvyk,

Bergmark

et al. 2024

JAMA Surg

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Section: Discussionmentioning

confidence: 99%

Perceived Implications of Compensation Structure for Academic Surgical Practice

Finn,

Syvyk,

Bergmark

et al. 2024

JAMA Surg

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“…Our research was not designed to assess provider group funding model preferences but suggests that these may be worth exploring. Recent Canadian research beyond the field of pregnancy care suggests that a notable proportion of specialists are interested in alternatives to FFS and suggests there may be untapped opportunity to shift to new funding models for physicians [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of funding models on the integration of Ontario midwives: a qualitative study

Darling,

Lemay,

Ejiwunmi

et al. 2023

BMC Health Serv Res

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Background Nearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada’s largest province, Ontario. Funding models have been identified as one of the main barriers. Methods Using a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal ‘integration’ as circumstances in which midwives’ knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis. Results We interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives’ scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs. Conclusions Significant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration.

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“…41 Physicians who provide care in community-level models are salaried employees; they do not receive remuneration on a fee-for-service, capitation, or other forms of financial incentive (eg, performance-based payment), 11 and this can be a helpful strategy for encouraging interprofessional collaboration, reducing health system expenditures, and facilitating equitable access to care. 43,44 Community-level models of care are governed by members of the community rather than by a board comprised of physicians. 1,11,12 Many other primary care models (eg, Family Health Teams and Patient Medical Home models) are predominately governed and led by physicians or others who are not necessarily members of the community in which the centre serves.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Community-informed, integrated, and coordinated care through a community-level model: A narrative synthesis on community hubs

Manis

Bielska

Cimek³

et al. 2021

Healthc Manage Forum

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We identify the core services included in a community hub model of care to improve the understanding of this model for health system leaders, decision-makers in community-based organizations, and primary healthcare clinicians. We searched Medline, PubMed, CINAHL, Scopus, Web of Science, and Google from 2000 to 2020 to synthesize original research on community hubs. Eighteen sources were assessed for quality and narratively synthesized (n = 18). Our analysis found 4 streams related to the service delivery in a community hub model of care: (1) Chronic disease management; (2) mental health and addictions; (3) family and reproductive health; and (4) seniors. The specific services within these streams were dependent upon the needs of the community, as a community hub model of care responds and adapts to evolving needs. Our findings inform the work of health leaders tasked with implementing system-level transformations towards community-informed models of care.

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Factors that influence specialist physician preferences for fee-for-service and salary-based payment models: A qualitative study

Cited by 9 publications

References 17 publications

Perceived Implications of Compensation Structure for Academic Surgical Practice

Perceived Implications of Compensation Structure for Academic Surgical Practice

The impact of funding models on the integration of Ontario midwives: a qualitative study

Community-informed, integrated, and coordinated care through a community-level model: A narrative synthesis on community hubs

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