Payment mechanisms and the composition of physician practices: balancing cost-containment, access, and quality of care.

Abstract:

:We take explicit account of the way in which the supply of physicians and patients in the economy affects the design of physician remuneration schemes, highlighting the three-way trade-off between quality of care, access, and cost. Both physicians and patients are heterogeneous. Physicians choose both the number of patients and the quality of care to provide to their patients. When determining physician payment rates, the principal must ensure access to care for all patients. When physicians can adjust the number of patients seen, there is no incentive to over-treat. In contrast, altruistic physicians always quality stint: they prefer to add an additional patient, rather than to increase the quality of service provided. A mixed payment mechanism does not increase the quality of service provided with respect to capitation. Offering a menu of compensation schemes may constitute a cost-effective strategy for inducing physicians to choose a given overall caseload but may also generate difficulties with access to care for frail patients.

journal_name

Health Econ

journal_title

Health economics

authors

Barham V,Milliken O

doi

10.1002/hec.3069

subject

Has Abstract

pub_date

2015-07-01 00:00:00

pages

895-906

issue

7

eissn

1057-9230

issn

1099-1050

journal_volume

24

pub_type

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