Global expenditure budgets in the fee-for-service physician sector create management problems for both funders and physicians.
Global expenditure cap policies must be designed, and appropriate institutional structures created, to mitigate perverse utilization incentives, manage collective utilization, and diffuse the internal professional and the funder-profession tensions created by a capped budget.
Two Canadian provinces that adopted different approaches to the design of their physician expenditure cap policies experienced different outcomes in utilization growth.
The outcomes, however, are the opposite to what one would predict based on an analysis of the incentive structures embodied in the two provinces'policies.
An analytic framework developed for the study of common-property resources is applied to the differing physician responses to global budgets across the two provinces.
The insights offered by this framework can guide policy design for global physician budgets, and they indicate the critical importance of physician acceptance of such a policy.
Mots-clés Pascal : Dépense, Contrôle coût, Médecin, Personnel sanitaire, Budget, Allocation ressource, Politique sanitaire, Economie santé, Incitation, Rémunération, Système santé, Alberta, Canada, Amérique du Nord, Amérique, Nouvelle Ecosse, Budget global, Paiement à l'acte
Mots-clés Pascal anglais : Expenditure, Cost control, Physician, Health staff, Budget, Resource allocation, Health policy, Health economy, Incentive, Remuneration, Health system, Alberta, Canada, North America, America, Nova Scotia
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0550624
Code Inist : 002B30A01B. Création : 24/03/1998.