Physician Payment Mechanisms

Financing Health Care: New Ideas for a Changing Society

Volumn , Issue , 2008, Pages 149-176

  Léger, Pierre Thomas ^a  

^a HEC MONTRÉAL   (Canada)

Author keywords

Capitation; Fee for service (FFS); Fully prospective payments; Mixed payment systems; Model of health care consumption; Model of health care provision; Physician payment mechanisms

Indexed keywords

EID: 85018648714     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.1002/9783527611294.ch7     Document Type: Chapter

References (46)

1. Newhouse, J. P. (1993) Free For All? Lessons from the RAND Health Insurance Experiment, Harvard University Press, Cambridge, for a thorough discussion of the effects of patient cost-sharing on the use of medical services.
2. Ellis, R.P., McGuire, T.G. (1986) Provider Behavior under Prospective Reimbursement: Cost Sharing and Supply. Journal of Health Economics, 5, 128-151.
3. Arrow, K. (1963) Uncertainty and the Welfare Economics of Medical Care. American Economic Review 53, 941-969.
4. Pauly, M. V. (1970) Efficiency, Incentives and Reimbursement for Health Care. Inquiry, 7, 114-131.
5. McGuire, T.G. (2000) Physician Agency. In: The Handbook of Health Economics, Vol. 1, Culyer, A.J., Newhouse, J.P. (Eds.), Elsevier Science B.V., Amsterdam, pp. 461-538.
6. Gaynor, M. (1994). Issues in the industrial organization of the market for physician services. Journal of Economics and Management Strategies, 39, 211-255).
7. Evans, R.G. (1974) Supplier-induced demand: some empirical evidence and implications. In: The Economics of Health and Medical Care, Perlman, M. (Ed.), MacMillan, London, pp. 162-173.
8. Stano, M. (1987) A further analysis of the physician inducement controversy. Journal of Health Economics 6, 229-238.
9. Rochaix, L. (1989) Information asymmetry and search in the market for physician services. Journal of Health Economics, 8, 53-84.
10. Gruber, J., Owings, M. (1996) Physician financial incentives and Cesarean section delivery. Rand Journal of Economics, 27, 99-123.
11. Yip, W. (1998) Physician responses to medical fee reductions: changes in volume and intensity of supply of Coronary Artery Bypass Graft (CABG) surgeries in the medicare and private sector. Journal of Health Economics, 7, 675-700.
12. Auld, M.C., Emery, J.C.H., Lu, M. (1999) Paying for Physician Services in Canada, University of Calgary (unpublished manuscript).
13. Frank, P., Clancy C.M. (1997) Referrals of Adult Patients from Primary Care: Demographic Disparities and their Relationship to HMO Insurance. Journal of Family Practice, 45, 45-53, report that 4.5% of all visits to primary care in the US resulted in a referral to specialty or hospital care.
14. Blomqvist, Å., Léger P.T. (2005) Information Asymmetry, Insurance and the Decision to Hospitalize. Journal of Health Economics, 24, 775-793.
15. Grembowski, D.E., Cook K., Patrick D.L., Roussel, A.E. (1998) Managed Care and Physician Referral. Medical Care Research and Review, 55, 3-31.
16. Allard, M., Jelovac, I., Léger, P.T. (2007) Physician Payment Mechanisms: Dynamics, Diagnostic Ability and Altruism, HEC Montréal (unpublished working paper).
17. Feldstein, P.J. (2004) Health Care Economics, 6th edition, Thomson Delmar Learning, p. 221.
18. Selder A. (2005) Physician reimbursement and technology adoption. Journal of Health Economics, 24, 907-930.
19. Selden, T.M. (1990) A Model of Capitation. Journal of Health Economics, 9, 397-409.
20. Crump, B.J., Cubbon, J.E., Drummond, M.F., Hawkes, R.A., and Marchment, M.D. (1991) Fund-holding in general practice and financial risk. British Medical Journal, 302, 1582-1584, for a more comprehensive description of the fundholding system.
21. Croxson, B., Propper, C., and Perkins, A. (2001) Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme. Journal of Public Economics, 79, 375-398.
22. Gaynor, M., Rebitzer, J.B., and Taylor, L.J. (2004) Physician Incentives in Health Maintenance Organizations. Journal of Political Economy, 112, 915-931 for a recent article on the topic.
23. Hickson, G.B., Altemeier, W.A., and Perrin, J.M. (1987) Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in a Randomized Prospective Study. Pediatrics, 80, 344-350.
24. Hillman, A.L., Pauly, M.V., Kerstein, J.J. (1989) How to financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? New England Journal of Medicine, 321, 86-92.
25. Manning, W.G., Newhouse, J.P., Duan, N., Keeler, E.B., Leibowitz, A. (1987) Health insurance and the demand for medical care: evidence from a randomized experiment. American Economic Review, 77, 251-274.
26. Luft, H. (1981) Health Maintenance Organizations: Dimensions of Performance, Wiley, New York.
27. Siu, A. (1988) Use of the hospital in a randomized trial of prepaid care. Journal of the American Medical Association, 259, 1343-1346.
28. Warner, J.P., King, M., Blizard, R., McClenahan, Z., and Tang, S. (2000) Patient-held shared care records for individuals with mental illness: Randomized controlled evaluation. British Journal of Psychiatry, 177, 319-324)
29. Chandler, D., Hu, T., Meisel, M., McGowen, M., and Madison, K. (1997) Mental health costs, other public costs, and family burden among mental health clients in capitated integrated service agencies. Journal of Mental Health Administration, 24, 178-188.
30. Blomqvist (1991) considers an alternative specification where the physician is a double agent - that is, they weigh the benefits to their patients with the revenues of their hospital/health care organization.
31. Ellwood, P.M., Paul, B.A. (1986) Commentary: But what about quality? Inquiry, Spring, 135-140.
32. Davis, K., Rolland, D. (1990) Health Care Cost Containment, Johns Hopkins University Press, Baltimore.
33. Gold, M., Hurley, R., Lake, T., Ensor, T., Berenson, R. (1995) A national survey of the arrangements managed-care plans make with physicians. New England Journal of Medicine, 333, 1678-1683.
34. Gold, M., United States Physician Payment Review Commission, Mathematica Policy Research Inc., and Medical College of Virginia (1995) Arrangements between managed care plans and physicians: results from a 1994 survey of managed care plans, Selected External Research Series 3, Physician Payment Review Commission, Washington D.C.
35. Danzon, P.M. (1990) Medical malpractice: theory, evidence and public policy, Harvard University Press, Cambridge, MA.
36. Léger, P.T. (2000) Quality Control Mechanisms under Capitation Payment for Medical Services. Canadian Journal of Economics, 33, 564-588.
37. Van de Ven, W. P. M. M., Ellis, R.P. (2000) Risk Adjustment in Competitive Health Plan Markets. In: The Handbook of Health Economics, 34 Vol. 1, Culyer, A. J., Newhouse, J. P. (Eds.), Elsevier Science B.V., Amsterdam.
38. Ellis, R.P. (1998) Creaming, Skimping and Dumping: Provider Competition on the Intensive and Extensive Margins. Journal of Health Economics, 17, 537-555.
39. Dafny, L.S. (2005) How Do Hospitals Respond to Price Changes? American Economic Review, 95, 1525-1547, for a recent article on the subject.
40. Hurley, R.E., Freund, D.A., Gage, B.J. (1991) Gatekeeping Effects on Patters of Physician Use. Journal of Family Practice, 32, 164-170
41. Gravelle, H., Dusheiko, M., Sutton, M. (2002) The demand for elective surgery in a public system: time and money prices in the UK National Health Service. Journal of Health Economics, 21, 423-449.
42. McGuire, T.G. (2006) Physician Fees and Behavior: Implications for Structuring a Fee Schedule, Department of Health Care Policy, Harvard Medical School (unpublished manuscript).
43. Ma, C-T. A., McGuire, T.G. (1997), Optimal Health Insurance and Provider Payment. American Economic Review, 87, 685-704.
44. Allard, M., Léger, P.T., Rochaix, L. (2006) Provider Behaviour under Competition, HEC Montréal (unpublished manuscript).
45. Eggleston, K. (2005) Multitasking and mixed systems for provider payment. Journal of Health Economics, 24, 211-223.
46. Bernard, F., Jacquemet, N., Shearer, B. (2006) Compensation, Incentives and the Practice Patterns of Physicians: Theory and Evidence from Micro-data, Université Laval (unpublished manuscript).