Background Managed-care organizations'use of financial incentives to influence the practice of primary care physicians is controversial.
We studied the prevalence and effects of these incentives.
Methods We surveyed a probability sample of primary care physicians practicing in the largest urban counties in California in 1996.
The physicians were asked about the types of incentives they encountered, the amount of income that was keyed to incentives, their experience of pressure in their practices, and the ways in which such pressure affected patient care.
Results Data were analyzed for 766 physicians involved in managed-care systems.
Thirty-eight percent of these physicians reported that their arrangements with the managed-care system included some type of incentive in the form of a bonus.
Fifty-seven percent of the physicians reported that they felt pressure from the managed-care organization to limit referrals (17 percent said they believed such pressure compromised patient care), and 75 percent felt pressure to see more patients per day (24 percent believed such pressure compromised patient care).
The physicians who reported that their financial arrangements included an incentive based on referrals were more likely than others to have felt pressure to limit referrals in a manner that compromised care.
(adjusted odds ratio, 2.5 ; 95 percent confidence interval, 1.2 to 5. (...)
Mots-clés Pascal : Etats Unis, Amérique du Nord, Amérique, Homme, Médecine, Soin santé primaire, Organisation santé, Economie santé, Analyse coût efficacité, Pratique professionnelle, Analyse statistique
Mots-clés Pascal anglais : United States, North America, America, Human, Medicine, Primary health care, Public health organization, Health economy, Cost efficiency analysis, Professional practice, Statistical analysis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0022282
Code Inist : 002B30A04B. Création : 31/05/1999.