Impact of payment model on the behaviour of specialist physicians: A systematic review

Quinn, Amity E.; Trachtenberg, Aaron J.; McBrien, Kerry; Ogundeji, Yewande Kofoworola; Souri, Sepideh; Manns, Liam; Rennert-May, Elissa; Ronksley, Paul E.; Au, Flora; Arora, Nikita; Hemmelgarn, Brenda R.; Manns, Braden

doi:10.1016/j.healthpol.2020.02.007

Cited by 27 publications

(37 citation statements)

References 26 publications

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“…It has been already noticed in a literature that compared to FFS, introduction of capitation model results in less patient visits, lesser continuity of care, but patients are more satisfied with access to a doctor [42]. Replacing FFS payments with capitation models most often leads to a smaller number of medical services, not only in the area of primary care but also in area of ambulatory care, and to fewer elective surgeries (e.g., cataracts and tubal ligation) [43]. FFS is typically associated with more primary care visits/contacts (about 5-7% more compared to capitation), as well as more specialist visits and more diagnostic and therapeutic services.…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland

Korneta

Kludacz-Alessandri

Walczak

2021

IJERPH

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In Poland, as in many other countries, the use of capitation payment schemes in primary health care is popular. Despite this popularity, the subject literature discusses its role in decreasing the quality of primary medical services. This problem is particularly important during COVID-19, when medical entities provide telehealth services to patients. The objective of the study is to examine the effects of COVID-19 pandemic on the performance of the primary health care providers in Poland under a capitation payment scheme. In this study the authors use data from interviews with personnel of medical entities and financial and administrative reports of primary health care providers in order to identify how this crisis situation impacts the performance of primary health care entities, under capitation payment system. The performance indicators include both the financial and quality measures. Selected to the case study primary health care service providers significantly improved their profitability due to considerable costs savings and reduction of services provided to patients in a time of COVID-19 pandemic. Capitation payment system proved to be inefficient, in the studied pandemic period, in terms of the services provided by primary health care service providers to patients and the funds paid to them, in exchange, by the government entities.

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Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland

Korneta

Kludacz-Alessandri

Walczak

2021

IJERPH

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“…23 With perverse incentives potentially leading to service distortion, policy-makers attempt to balance incentives by mixing different types of payments, 7,24 or by creating risk-adjusted payments such as capitations or diagnosis-related groups (DRGs). 22 While the debate over how economic incentives are translated into healthcare providers' actions is not new, [25][26][27][28] it is important to note that providers are motivated by other considerations apart from financial ones, such as professional norms and status. 7 Professional norms include, inter alia, quality of care and the regard for the patient.…”

Section: Physician Agency and Dilemmas Between Economic And Clinical Considerationsmentioning

confidence: 99%

Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?

Waitzberg

Gottlieb

Quentin

et al. 2021

Int J Health Policy Manag

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Background: Hospital professionals are "dual agents" who may face dilemmas between their commitment to patients’ clinical needs and hospitals’ financial sustainability. This study examines whether and how hospital professionals balance or reconcile clinical and economic considerations in their decision-making in two countries with activity-based payment systems. Methods: We conducted 46 semi-structured interviews with hospital managers, chief physicians and practicing physicians in five German and five Israeli hospitals in 2018/2019. We used thematic analysis to identify common topics and patterns of meaning. Results: Hospital professionals report many situations in which activity-based payment incentivizes proper treatment, and clinical and economic considerations are aligned. This is the case when efficiency can be improved, eg, by curbing unnecessary expenditures or specializing in certain procedures. When considerations are misaligned, hospital professionals have developed a range of strategies that may contribute to balancing competing considerations. These include ‘reshaping management,’ such as better planning of the entire course of treatment and improvement of the coding; and ‘reframing decision-making,’ which involves working with averages and developing tool-kits for decision-making. Conclusion: Misalignment of economic and clinical considerations does not necessarily have negative implications, if professionals manage to balance and reconcile them. Context is important in determining if considerations can be reconciled or not. Reconciling strategies are fragile and can be easily disrupted depending on context. Creating tool-kits for better decision-making, planning the treatment course in advance, working with averages, and having interdisciplinary teams to think together about ways to improve efficiency can help mitigate dilemmas of hospital professionals.

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“…It is proved that the payment methods preferred by patients, namely the collaboration of the physician with the health insurance fund, and, in this case, some expenses are covered for the insured patients, radically influence the relationship with patients. These models influence the perception upon the quality of medical services and improve the patients' trust [38]. The relationship of the employer and the private clinic with the medical staff regarding their payment method was also analyzed.…”

Section: Introductionmentioning

confidence: 99%

Patient Satisfaction with Private Recovery Services and Importance of Physician Behavior during COVID Time

et al. 2021

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Introduction: Patient satisfaction represents an essential indicator of the quality of care in the medical recuperation sector. This study aimed to identify the degree of satisfaction in patients who benefit from medical recuperation services in one private clinic from Romania and the factors that played a part in this respect. Method: An online questionnaire was completed by 105 patients of a private clinic in the period immediately following the opening of the clinic after the quarantine period due to COVID-19. The following concepts were measured: general satisfaction with clinical recuperation services (SG), physician’s behavior (PB), the impact of interventions on the state of health (IHI), modern equipment (ME), and the intention to return to the clinic (IRC). Based on a linear regression model, the impact of PB, IHI, ME, and IRC variables on general satisfaction (SG) was established. Results: The study results confirm the data from studies carried out in different sociocultural contexts in ordinary time, where physician behavior is the most crucial factor in patients’ satisfaction. Therefore, we can say that the physiotherapist’s behavior has an essential role in determining the patients’ satisfaction both in ordinary time and in COVID-19 time. The data in this study reflect the fact that satisfaction with the services offered by a medical recuperation clinic is a predictor for using the services in the future. Still, our study reflects a moderate relationship in intensity.

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Impact of payment model on the behaviour of specialist physicians: A systematic review

Cited by 27 publications

References 26 publications

The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland

The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland

Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?

Patient Satisfaction with Private Recovery Services and Importance of Physician Behavior during COVID Time

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