The effect of capitated and fee-for-service remuneration on physician decision making in gynecology.
To evaluate the variations in physician behavior leading to performance of gynecologic surgical procedures related to fee-for-service and capitation reimbursement systems.
This study compared the physician practice utilization of surgical services for fee-for-service and capitated contract reimbursement systems within a gynecology clinic.
Attending gynecologists were reimbursed on a fee-for-service basis for all surgical services performed during a 6-month interval ; subsequently, the same physicians were reimbursed on a capitated basis for 6 months and received a fixed payment for the clinical and surgical services provided.
Three thousand seven hundred eighty consecutive outpatient gynecology visits were evaluated at the university gynecology clinic during 1994.
We found a 15% overall decrease in the number of surgical procedures that were performed during the capitated reimbursement period compared with the fee-for-service time interval.
The procedure most responsible for the reduction of surgical services was elective sterilization by laparoscopy, which underwent a statistically significant decrease (P<. 01).
The remuneration system in our review seemed to affect physician decision making for only the most elective procedures, whereas physicians maintained similar practice patterns for more severe conditions.
Fee-for-service seems to encourage, whereas capitation seems to discourage, gynecologists from perfo...
Mots-clés Pascal : Gynécologie, Chirurgie, Médecin, Paiement, Economie santé, Clinique, Homme
Mots-clés Pascal anglais : Gynecology, Surgery, Physician, Payment, Health economy, Clinic, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0245797
Code Inist : 002B30A04B. Création : 199608.