Show simple item record

dc.creatorGrumbach, Kevinen
dc.creatorOsmond, Dennisen
dc.creatorVranizan, Karenen
dc.creatorJaffe, Deborahen
dc.creatorBindman, Andrew B.en
dc.date.accessioned2015-05-05T19:06:45Zen
dc.date.available2015-05-05T19:06:45Zen
dc.date.created1998-11-19en
dc.date.issued1998-11-19en
dc.identifier10.1056/NEJM199811193392106en
dc.identifier.bibliographicCitationNew England Journal of Medicine. 1998 Nov 19; 339(21): 1516-1521.en
dc.identifier.issn0028-4793en
dc.identifier.urihttp://worldcatlibraries.org/registry/gateway?version=1.0&url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&atitle=Primary+Care+Physicians'+Experience+of+Financial+Incentives+In+managed-Care+Systems&title=New+England+Journal+of+Medicine.++&volume=339&issue=21&pages=1516-1521&date=1998&au=Grumbach,+Kevinen
dc.identifier.urihttp://dx.doi.org/10.1056/NEJM199811193392106en
dc.identifier.urihttp://hdl.handle.net/10822/756261en
dc.description.abstractBACKGROUND: 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 pressured to limit referrals in a manner that compromised care (adjusted odds ratio 2.5; 95 percent confidence interval, 1.2 to 5.0), and physicians with an incentive based on productivity were more likely to have felt pressure to see more patients that they believed compromised care (adjusted odds ratio, 2.1; 95 percent confidence interval, 1.2 to 3.8). The physicians whose health care systems used incentives keyed to productivity were less likely than others to be very satisfied with their practices (adjusted odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.6), whereas those whose systems included incentives related to the quality of care or patients' satisfaction were more likely to be very satisfied (adjusted odds ratio, 1.8; 95 percent confidence interval, 1.1 to 3.0). CONCLUSIONS: Many managed-care organizations include financial incentives for primary care physicians that are indexed to various measures of performance. Incentives that depend on limiting referrals or on greater productivity apply selective pressure to physicians in ways that are believed to compromise care. Incentives that depend on the quality of care and patients' satisfaction are associated with greater job satisfaction among physicians.en
dc.formatArticleen
dc.languageenen
dc.sourceBRL:MEDKIE/99025351en
dc.subjectAttitudesen
dc.subjectCoercionen
dc.subjectConsultationen
dc.subjectEconomicsen
dc.subjectHealthen
dc.subjectHealth Careen
dc.subjectIncentivesen
dc.subjectKnowledgeen
dc.subjectManaged Care Programsen
dc.subjectMethodsen
dc.subjectManaged Careen
dc.subjectOrganizationsen
dc.subjectPatient Careen
dc.subjectPatient Satisfactionen
dc.subjectPatientsen
dc.subjectPhysiciansen
dc.subjectPrevalenceen
dc.subjectPrimary Health Careen
dc.subjectProbabilityen
dc.subjectQuality of Health Careen
dc.subjectStatisticsen
dc.subjectSurveyen
dc.subjectWithholding Treatmenten
dc.titlePrimary Care Physicians' Experience of Financial Incentives in Managed-Care Systemsen
dc.provenanceDigital citation created by the National Reference Center for Bioethics Literature at Georgetown University for the BIOETHICSLINE database, part of the Kennedy Institute of Ethics' Bioethics Information Retrieval Project funded by the United States National Library of Medicine.en
dc.provenanceDigital citation migrated from OpenText LiveLink Discovery Server database named NBIO hosted by the Bioethics Research Library to the DSpace collection BioethicsLine hosted by Georgetown University.en


This item appears in the following Collection(s)

Show simple item record


Georgetown University Seal
©2009—2019 Bioethics Research Library
Box 571212 Washington DC 20057-1212
202.687.3885