Effects of Compensation Methods and Physician Group Structure on Physicians' Perceived Incentives to Alter Services to Patients
Open accessAbstract
Objective. To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients. Data Source. Nationally representative data on physicians are from the 2000–2001 Community Tracking Study Physician Survey (N=12,406). Study Design. Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither. Principal Findings. Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services. Conclusions. Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage.
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Gaps between research and practice can result from multiple factors, including educational/knowledge deficiencies and/or disagreements, time constraints for practitioners, lack of decision support tools and feedback mechanisms, poorly aligned incentives, and organizational climate and cultural factors.
“Thus far, the literature indicates that gaps between research and practice can result from multiple factors, including educational/knowledge deficiencies and/or disagreements,10,11 time constraints for practitioners,12,13 lack of decision support tools and feedback mechanisms,13 poorly aligned incentives,14 and a host of other organizational climate and cultural factors.2,15,16”
From Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact (2012) · cites this paper as [14]
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- Authors
- Reschovsky, J. D., Hadley, J., & Landon, B. E.
- Affiliations
- Center for Studying Health System Change (US)
- Harvard University (US)
- Corresponding author
- Reschovsky, James D.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2006-03-31
- Volume
- 41
- Issue
- 4p1
- Pages
- 1200-1220
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC1797096
- OpenAlex
- W1976766935
- Cited by
- 57
- References
- 31
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 3 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 5 · 2015: 3 · 2014: 4 · 2012: 5
- FWCI
- 12.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Services Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- Agency for Healthcare Research and Quality (P01-HS10803, P01 HS010803)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- physician remuneration, capitation, practice ownership, physician groups, health plan payment, variable compensation, productivity incentives, financial incentives, quality of care, patient satisfaction, health care costs, insurance coverage, physician perceptions
- MeSH terms
- Attitude of Health Personnel, Female, Group Practice, Health Maintenance Organizations, Humans, Interviews as Topic, Male, Physician Incentive Plans, Practice Patterns, Physicians', Physicians, Reimbursement Mechanisms, United States, Health Care Surveys
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