Money Talks - Paying Physicians for Performance

Keser, Claudia; Peterlé, Emmanuel; Schnitzler, Cornelius

doi:10.2139/ssrn.2357326

Cited by 14 publications

(12 citation statements)

References 36 publications

(61 reference statements)

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“…Using protocols like these, Hennig-Schmidt, Selten, and Wiesen (2011) and Green (2013) both find that medical and economics students, respectively, respond to fee-for-service and capitation as expected, with overuse in the former and underuse in the latter, to the detriment of patients in both studies. Keser, Peterle, and Schnitzler (2014) also found that fee-for-service payments led medical students to overuse, but that P4P tied to providing the optimal level of services (from the patient perspective) could mitigate this. However,…”

Section: Responses To Financial Incentivesmentioning

confidence: 99%

“…Using protocols like these, Hennig‐Schmidt, Selten, and Wiesen () and Green () both find that medical and economics students, respectively, respond to fee‐for‐service and capitation as expected, with overuse in the former and underuse in the latter, to the detriment of patients in both studies. Keser, Peterle, and Schnitzler () also found that fee‐for‐service payments led medical students to overuse, but that P4P tied to providing the optimal level of services (from the patient perspective) could mitigate this. However, although the expected responses to incentives were found generally, the effects were mitigated substantially by patient characteristics: sicker patients got more services than healthy patients under any payment scheme in all three studies.…”

Section: Section Ii: Novel Research That Informs the Policy Debatementioning

confidence: 99%

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How Financial and Reputational Incentives Can Be Used to Improve Medical Care

Roland

Dudley

2015

Health Services Research

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ObjectivesNarrative review of the impact of pay‐for‐performance (P4P) and public reporting (PR) on health care outcomes, including spillover effects and impact on disparities.Principal FindingsThe impact of P4P and PR is dependent on the underlying payment system (fee‐for‐service, salary, capitation) into which these schemes are introduced. Both have the potential to improve care, but they can also have substantial unintended consequences. Evidence from the behavioral economics literature suggests that individual physicians will vary in how they respond to incentives. We also discuss issues to be considered when including patient‐reported outcome measures (PROMs) or patient‐reported experience measures into P4P and PR schemes.ConclusionWe provide guidance to payers and policy makers on the design of P4P and PR programs so as to maximize their benefits and minimize their unintended consequences. These include involving clinicians in the design of the program, taking into account the payment system into which new incentives are introduced, designing the structure of reward programs to maximize the likelihood of intended outcomes and minimize the likelihood of unintended consequences, designing schemes that minimize the risk of increasing disparities, providing stability of incentives over some years, and including outcomes that are relevant to patients' priorities. In addition, because of the limitations of PR and P4P as effective interventions in their own right, it is important that they are combined with other policies and interventions intended to improve quality to maximize their likely impact.

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Section: Responses To Financial Incentivesmentioning

confidence: 99%

Section: Section Ii: Novel Research That Informs the Policy Debatementioning

confidence: 99%

How Financial and Reputational Incentives Can Be Used to Improve Medical Care

Roland

Dudley

2015

Health Services Research

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“…One of the key benefits of using a lab experiment is that there exists a theoretically known and unique optimal quantity of medical care that maximizes the health benefit in each patient, and furthermore that it facilitates ceteris paribus variation in physician payment systems in a controlled environment. A robust finding in this experimental literature is that physicians provide more medical care under fee-for-service than under capitation, to the extent that patients are overtreated in fee-for-service and undertreated in capitation (Hennig-Schmidt et al 2011;Brosig-Koch et al 2013;Keser et al 2014;Hennig-Schmidt and Wiesen 2014;Brosig-Koch et al 2015. Moreover, Brosig-Koch et al 2013and Brosig-Koch et al (2015 investigate whether physicians provide better medical treatment under capitation or fee-for-service, and capitation seems to be the marginally better system in this respect.…”

Section: Introductionmentioning

confidence: 95%

Physician behavior and conditional altruism: the effects of payment system and uncertain health benefit

Martinsson

Persson

2019

Theory Decis

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This paper experimentally investigates the altruistic behavior of physicians and whether this behavior is affected by payment system and uncertainty in health outcome. Subjects in the experiment take on the role of physicians and decide on the provision of medical care for different types of patients, who are identical in all respects other than the degree to which a given level of medical treatment affects their health. We investigate physician altruism from the perspective of ethical principles, by categorizing physicians according to how well their treatment decisions align with different principles for priority setting. The experiment shows that many physicians are altruistic toward their patients but also that the degree of altruism varies across patients with different medical needs. We find a strong effect of payment system that is overall unaffected by the introduction of risk and ambiguity in patients' health outcomes. There is, however, substantial heterogeneity across individuals, in particular under the capitation payment system where physicians' responses to the introduction of uncertainty in patient health are modulated by their own generic risk and ambiguity preferences.

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“…First, it contributes to the recently emerging literature in experimental health economics. A series of laboratory experiments (Brosig-Koch et al 2013a, 2013b, Kairies and Krieger 2013, Keser et al 2014, Keser et al 2013, Green 2014 investigate incentive effects of remuneration systems for physician behavior. For example, Hennig-Schmidt et al (2011) compare a capitation system (in which the physician gets paid per patient independent of the treatment provided) and a fee-for-service system (in which payment does depend on the treatment provided).…”

mentioning

confidence: 99%

Medical Insurance and Free Choice of Physician Shape Patient Overtreatment: A Laboratory Experiment

et al. 2014

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In a laboratory experiment designed to capture key aspects of the interaction between physicians and patients, we study the effects of medical insurance and competition in the guise of free choice of physician, including observability of physicians' market shares. Medical treatment is an example of a credence good: only the physician knows the appropriate treatment, the patient does not. Even after a consultation, the patient is not sure whether he received the right treatment or whether he was perhaps overtreated. We find that with insurance, moral hazard looms on both sides of the market: patients consult more often and physicians overtreat more often than in the baseline condition. Competition decreases overtreatment compared to the baseline and patients therefore consult more often. When the two institutions are combined, competition is found to partially offset the adverse effects of insurance: most patients seek treatment, but overtreatment is moderated.

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Money Talks - Paying Physicians for Performance

Cited by 14 publications

References 36 publications

How Financial and Reputational Incentives Can Be Used to Improve Medical Care

How Financial and Reputational Incentives Can Be Used to Improve Medical Care

Physician behavior and conditional altruism: the effects of payment system and uncertain health benefit

Medical Insurance and Free Choice of Physician Shape Patient Overtreatment: A Laboratory Experiment

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