Managing The Physician: Rules Versus Incentives

Hillman, Alan L.

doi:10.1377/hlthaff.10.4.138

Cited by 70 publications

(29 citation statements)

References 8 publications

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“…Besides "rules" -which apart from licensing and accreditation include treatment protocols, practice guidelines, and utilization reviews -incentives are yet another set of instruments for quality promotion (Hillman, 1991). Typically financial in nature, incentives follow a reward and penalty system for certain clinical decisions.…”

Section: Incentives For Improvement In Qualitymentioning

confidence: 99%

Should we have confidence if a physician is accredited? A study of the relative impacts of accreditation and insurance payments on quality of care in the Philippines

Quimbo

Peabody

Shimkhada

et al. 2008

Social Science & Medicine

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It is unclear whether health provider accreditation ensures or promotes quality of care. Using baseline data from the Quality Improvement Demonstration Study (QIDS) in the Philippines we measured the quality of pediatric care provided by private and public doctors working at the district hospital level in the country's central region. We found that national level accreditation by a national insurance programme influences quality of care. However, our data also show that insurance payments have a similar, strong impact on quality of care. These results suggest that accreditation alone may not be sufficient to promote high quality of care. Further improvements may be achieved with properly monitored and well-designed payment or incentive schemes.

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Section: Incentives For Improvement In Qualitymentioning

confidence: 99%

Should we have confidence if a physician is accredited? A study of the relative impacts of accreditation and insurance payments on quality of care in the Philippines

Quimbo

Peabody

Shimkhada

et al. 2008

Social Science & Medicine

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show abstract

“…Managed care plans rely on financial incentives to constrain costs to varying degrees, but some rely heavily on this approach (Hillman 1991). Incentives of this sort may directly compromise quality of care and physician agency.…”

Section: Enhancing the Fidelity Of Agency Relationsmentioning

confidence: 99%

Countervailing Agency: A Strategy of Principaled Regulation under Managed Competition

Schlesinger

1997

Milbank Quarterly

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Despite the failure of recent attempts to reform health care, strategies of managed competition remain the dominant prescription for government oversight of managed care. A number of assumptions and prescriptions in the conventional managed competition model are challenged. More specifically, externalities in the costs and benefits associated with health care and asymmetric information between providers and patients make it unlikely that a managed care system designed to be responsive to consumers will, in practice, produce socially desirable outcomes. An alternative approach for the regulation of managed care more explicitly protects the role of health care professionals as agents for their patients while defining the appropriate role of managed care as the agent for broader societal interests. This strategy of “countervailing agency”acknowledges that oversight of managed care inevitably involves value‐laden choices. It is based on institutional arrangements and regulatory strategies that are intended to balance competing interests and values.

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“…39,40 Hillman comments, 'whereas most physicians will act in the patient's best interest when the medical decision is clear-cut, the effect of financial incentives may be most important in cases where the correct decision is not obvious'. 39 In a later paper, Hillman 41 compares the alternative use of rules (including practice guidelines) and incentives in inducing appropriate behaviour under conditions involving medical uncertainty. Incentives provide indirect economic influences on clinical decisions.…”

Section: Incentives and Physician Behaviourmentioning

confidence: 99%

An incentive approach to physician implementation of medical practice guidelines

Sonnad

Foreman

1997

Health Econ.

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We propose a probabilistically based incentive payment system for guideline implementation that provides rewards for physicians who follow practice guidelines and additional remuneration for physician leaders who engage in information sharing. All payments are based on observed outcomes of patient treatment. A fixed base payment forms the core of the system with probabilistic offsets calculated from the chance that a 'good' outcome occurs without optimal treatment or information. The system pays different physician types for different task sets.

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Managing The Physician: Rules Versus Incentives

Cited by 70 publications

References 8 publications

Should we have confidence if a physician is accredited? A study of the relative impacts of accreditation and insurance payments on quality of care in the Philippines

Should we have confidence if a physician is accredited? A study of the relative impacts of accreditation and insurance payments on quality of care in the Philippines

Countervailing Agency: A Strategy of Principaled Regulation under Managed Competition

An incentive approach to physician implementation of medical practice guidelines

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